Growth Hormone Deficiency

Question 1

Where is the growth hormone produced?

Answer 1

Anterior pituitary

Question 2

What is the function of the growth hormone in the body?

Answer 2

Stimulating cell reproduction and the growth of organs, muscles, bones and height

Question 3

What effect does growth hormone have on the liver?

Answer 3

It stimulates the release of insulin-like growth factor 1 (IGF-1) by the liver

Question 4

Why is IGF-1 important?

Answer 4

Promotes growth in children and adolescents.

Question 5

What is congenital growth hormone deficiency due to?

Answer 5

A disruption to the growth hormone axis at the hypothalamus or pituitary gland.

Question 6

What can congenital growth hormone deficiency be due to?

Answer 6

Genetic mutations

Empty sellae syndrome

Question 7

Mutations of which genes can result in growth hormone deficiency?

Answer 7

• GH1 (growth hormone 1) gene

* GHRHR (growth hormone releasing hormone receptor) gene

Question 8

What is Empty sellae syndrome?

Answer 8

The pituitary gland is under-developed or damaged.

Question 9

What can acquired growth hormone deficiency be due to?

Answer 9

• Infection
• Trauma
• Interventions such as surgery

Question 10

How can growth hormone deficiency occur?

Answer 10

Alone

In combination with other pituitary hormone deficiencies

Question 11

Which other pituitary hormone deficiencies can growth hormone deficiency occur with?

Answer 11

• Hypothyroidism
• Adrenal insufficiency
• Deficiencies of the gonadotrophins (LH and FSH).

Question 12

How can growth hormone deficiency occur at birth and in neonates?

Answer 12

• Micropenis (in males)
• Hypoglycaemia
• Severe jaundice

Question 13

How can growth hormone deficiency present in infants and older children?

Answer 13

• Poor growth, usually stopping or severely slowing from age 2-3
• Short stature
• Slow development of movement and strength
• Delayed puberty

Question 14

What is the main investigation for Growth hormone deficiency?

Answer 14

Growth hormone stimulation test

Question 15

What does growth hormone stimulation test involve?

Answer 15

Measuring the response to medications that normally stimulate the release of growth hormone.

Question 16

What medication can be used to stimulate growth hormone?

Answer 16

Glucagon
Insulin
Arginine
Cllonidine.

Question 17

When are growth hormone levels measured after administering the medication?

Answer 17

2-4 hours after administering the medication to assess the hormonal response.

Question 18

What other investigations could be done in someone with growth hormone deficiency?

Answer 18

• Test for other associated hormone deficiencies- thyroid and adrenal deficiency
• MRI brain for structural pituitary or hypothalamus abnormalities
• Genetic testing for associated genetic conditions such as Turner syndrome and Prader–Willi syndrome

Question 19

What is the management of growth hormone deficiency?

Answer 19

Daily subcutaneous injections of growth hormone (somatropin)

Question 20

What needs to be closely monitored in a patient with growth hormone deficiency?

Answer 20

Height and Development