It may be quite traumatizing when you realize that you or your child has been diagnosed with a hormonal deficiency – especially, growth hormone deficiency (GHD). Several questions may start popping up in your mind: how dangerous is growth hormone deficiency? Can it be cured? What should you expect of the condition? What can you do to remedy for the condition? Here are some answers and expert explanations on the complete manifestation of this condition.
What Is Growth Hormone Deficiency
Let’s start by making it simple and easy to understand.
Growth hormone is the hormone produced by the anterior portion of the pituitary and secreted directly into the blood for transport to is target tissues. A deficiency on the other hand
means an insufficient cum inadequate production of growth hormone or just no production of the hormone at all.
Growth hormone deficiency can either be congenital or acquired. Congenital means it is present at birth in infants due to a developmental problem that occurred during pregnancy. The acquired form of growth hormone deficiency usually presents in adulthood and may be due to a myriad of causes as we shall see below.
Growth Hormone Deficiency Prevalence
How common is growth hormone deficiency? Does it affect children more than adults or vice versa? Well, here are some facts for these questions. A particular research posted in the National Center for Biotechnology Information (NCBI) found out that the prevalence of growth hormone deficiency can be estimated at approximately 1:4,000 to 1:10,000 in childhood.
In adults, the prevalence is estimated at approximately 1: 100,000. It was also found that: when both childhood and adulthood growth hormone deficiency are considered, the annual incidence for the condition becomes 2 cases per 100,000.
Growth Hormone Deficiency Disease
Growth hormone deficiency disease refers to the classic clinical presentations that accompany lack of or insufficient production of growth hormone. It is often associated with inadequate production of other pituitary hormones. In such a situation where other pituitary hormones are inadequately produced, the condition is referred to as combined pituitary hormone deficiency.
However, when growth hormone deficiency is not accompanied by any other hormonal deficiency, the condition is called, isolated growth hormone deficiency.
Isolated growth hormone deficiency
Just as the name suggests, isolated growth hormone deficiency is a condition where there is severe shortage or absence of growth hormone, though, without any other hormonal problem. Like other cases of growth hormone deficiency, people with isolated growth hormone deficiency have an unusually short stature due to failure to grow at the expected rate.
Complete absence of growth hormone is classified as Type 1A isolated growth hormone deficiency. In more ways than one, this is the most severe form of the deficiency disease out of all the four types. The classic presentation of this disease is very evident at birth because the affected babies are usually shorter than expected when they are born.
Type 1B isolated growth hormone deficiency is somewhat less severe than the type 1A condition because there is at least some production of growth hormone in Type 1B, though the production is still insufficient. This disease presents mostly in toddlers. Ideally, it can be identified clinically the early mid childhood due to growth failure.
In Type II isolated growth hormone deficiency, the growth hormone levels are also very low. What makes this condition stand out is that it presents with growth failure that can be evident in early to mid-childhood. The short stature accompanied by this condition also varies in severity. On average, nearly 50% of the individuals with this type of deficiency suffer from a condition called pituitary hypoplasia – a condition where the pituitary is underdeveloped.
The fourth type of isolated growth hormone deficiency is Type III. It is quite similar to type II in the sense that the affected individuals have inadequate growth hormone levels and a short stature that vary in severity. But unlike type II, patients with type III isolated growth hormone deficiency have a simultaneous weakening of the immune system.
What is Partial growth hormone deficiency?
Simply put, partial growth hormone deficiency is when the production of growth hormone is not completely absent. There is some little production of the hormone, though the amount is relatively too low to ensure a normal growth pattern in the affected individuals.
What is Idiopathic growth hormone deficiency?
In medicine, anything idiopathic is something whose cause or etiology is unknown. For instance, isolated growth hormone deficiency is usually caused by a mutation is certain genes. This is what is widely accepted to be the congenital causes. However, there are patients with isolated growth hormone deficiency, though without these gene mutations. In such patients, the cause of the deficiency is unknown and therefore, the condition is termed as idiopathic growth hormone deficiency.
What is Pediatric growth hormone deficiency?
Pediatric simply means: anything pertaining to the health of infants, babies, toddlers, children or adolescents. Pediatric growth hormone deficiency refers to the GHD that occurs in children. Pediatric growth hormone deficiency can either be acquired or congenital.
What Are the Causes and Symptoms of Growth Hormone Deficiency?
The causes of growth hormone deficiency vary with age. For instance, congenital causes that manifest in babies is different form the acquired causes. Causes of growth hormone deficiency can be broadly classified as either primary or secondary.
- Primary causes of growth hormone deficiency
Primary causes of any condition refers to the complication that affect the exact organ or structure where it is produced. For growth hormone, primary causes are those factors that affect the pituitary gland where growth hormone is produced.
- Secondary causes of growth hormone deficiency
Secondary causes are factors that alter the production of growth hormone by influencing other sites other than the site of production of the hormone. For instance, growth hormone is secreted from the pituitary gland by the stimulatory action of another hormone called growth hormone releasing hormone (GHRH).
Any factor that affects the hypothalamus will impair the production and/or synthesis of GHRH. As a result, the pituitary will be normal but there will be no stimulatory factor to cause synthesis and release of growth hormone. Such patients also present with growth hormone deficiency albeit with fully functional pituitary gland.
General cause of growth hormone deficiency
These are the specific causes of GHD. They can either be primary or secondary cause depending on the site that they affect – either hypothalamus or pituitary. Here are some of the causes of GHD:
Hypopituitarism refers to the diminished hormonal production by the pituitary gland. It can occur due to several cause such as:
- Empty sella syndrome
Anatomically, the pituitary sits in a sac like bony structure called the sella turcica. In empty sella syndrome, this structure is compromised hence causing hypopituitarism. The causes of empty sella syndrome can either be primary or secondary.
Primary causes are majorly congenital defects in the sella turcica which causes herniation of the brain structure into the sac. This compresses the pituitary which consequently reduces its functional ability – hence hypopituitarism.
Secondary cause of empty sella syndrome is majorly trauma to the head such as in automobile accident. The trauma may end up damaging the pituitary gland hence causing hypopituitarism.
- Sheehan’s syndrome
Sheehan’s syndrome is a major complication that is common in women just after birth. The condition is sometimes called postpartum pituitary gland necrosis. Physiologically, pregnancy requires copious production of several hormones. As a result, the pituitary gland enlarges.
However, when a woman finally gives birth, she losses a lot of blood and her body fluid volume decreases. The pituitary gland is very sensitive to inadequate blood supply. Since it grew in size during pregnancy, severe blood loss directly affects the pituitary causing it to die, what is usually called pituitary necrosis. This directly causes hypopituitarism.
Tumors are masses which may arise in the pituitary. Tumors that causes hypopituitarism are mostly nonfunctional, meaning: they don’t produce any hormones. Functional tumors will produce excess hormones and won’t cause a deficiency. Common tumors causing hypopituitarism are pituitary adenoma in adult and craniopharyngioma in children.
- Genetic abnormalities
Probably, there are two main questions that may be running in your mind now after reading “genetic abnormalities.”
Is growth hormone deficiency genetic? Is growth hormone deficiency hereditary? The answers to these questions may be:
Yes, and No – or maybe both. I’ll explain.
Isolated growth hormone deficiency usually occurs as a result of certain gene mutations. There are three specific gene mutations that can cause isolated GHD. They include: GH1, GHRHR, or BTK genes. When viewed in line with these mutations, growth hormone deficiency can be termed as genetic.
However, there are non-genetic causes of GHD such as those described previously.
So, depending on which angle you look at it, growth hormone deficiency can either be: genetic because it involves genes, non-genetic because there are acquired causes, hereditary because it occurs in 3% of all cases or non-hereditary because 97% of the cases are isolated without any genetic predisposition.
- Radiation therapy for the treatment of certain cancers of the brain, head and neck may end up damaging the pituitary gland or the hypothalamus.
Diseases such as those cause by bacteria, viruses and fungi can infiltrate into the brain substance and affect both the pituitary and the hypothalamus.
Growth Hormone Deficiency in Adults – Symptoms
Sometimes you may present with symptoms that may make you ask yourself:
Do I have a growth hormone deficiency?
Well, before you draw any conclusions, you may have to watch for several other related symptoms. Besides, your doctor will have to make a conclusive diagnosis based on your presenting symptoms and reports from the laboratory.
So, what are the symptoms of GHD in adults?
Symptoms of GHD are often due to the impaired action of growth hormone in its various target tissues. The symptoms in adults include:
- Baldness in men
- Difficulty in concentration or loss of memory
- Decreased muscle mass
- Reduced total body strength
- Anxiety and depression
- Decreased sexual interest and/or sexual function
- High triglyceride levels in the body
- Heart diseases
- Insulin resistance
- Exercise intolerance
- Reduced bone density
- Weight gain and increased belly fat
- Dry and thin skin
You may experience a combination of any of the symptoms mentioned above. In severe conditions, you may actually present with more than 90% of these symptoms.
Growth Hormone Deficiency in Child – Symptoms
Congenital growth hormone deficiency is the major cause of GHD in children. Congenital GHD can be due to genetic problems or impaired development of brain structures. Nevertheless, the disease can always be picked up early and prompt treatment started to alleviate some of the adverse symptoms.
Symptoms of GHD in children include:
- Growth hormone deficiency facial features such as appearing younger than children of the same age.
- The puberty of the child may be delayed. Is some circumstances, the child may not go to puberty at all.
- Fat may be increasingly deposited in the face and around the abdomen.
- The child may present with sluggish hair growth.
Slow tooth development is also a common symptom.
Growth Hormone Deficiency Treatment
Growth hormone deficiency can be effectively managed by hormone therapy. Serious conditions may sometimes require long term therapy with hormone supplements.
Here is how to treat growth hormone deficiency:
- Growth hormone releasing hormone analogues
Growth hormone releasing hormone analogues are majorly used for research purposes. Though, a few examples such as Sermorelin which is a functional peptide of GHRH is used for diagnosis and treatment of impaired growth hormone secretion. Recently in 2010, the FDA approved another GHRH analogue, Tesamorelin, for the treatment of abnormal distribution of fat in the body (lipodystrophy) of people living with HIV.
- Growth hormone analogues
Somatotropin is the growth hormone analogue that is usually administered via injections to manage growth hormone deficiency and most of the idiopathic growth disorders. Somatotropin is the generic name, however, there are other brand names such as Genotopin, Humatrope, Norditopin, Nutripin, Serostim and Zorbtive.
- Recombinant insulin like growth factor 1
Sometimes the effect of growth hormone deficiency is not really due to growth hormone but due to a secondary hormone that is activated by growth hormone – IGF-1. For such conditions, a recombinant human IGF-1 called Mecasermin can be used in severe IGF-1 deficiency. The important adverse effect of this drug which you should note is hypoglycemia.
What is the growth hormone deficiency treatment cost?
As effective as the therapies may be, their benefits do not come cheaply. Ideally, the treatment price for human growth hormone therapy is estimated to be between $10,000 to $60,000 per year. It is normally administered 6 to 7 days per week.
Growth Hormone Deficiency Guidelines
The following guidelines are the recommendation when managing and/or treating growth hormone deficiency in adult patients:
- Patients who should be evaluated for acquired form of growth hormone deficiency are those who have undergone surgery or chemotherapy in the head and neck as well as those with structural hypothalamic/pituitary disease. Patients with an evident pituitary hormone deficiency are also included in this category.
- Idiopathic GHD is very rare in adults. As a result, stringent guidelines have been put in place before you conclude a diagnosis of this condition. This is because the diagnostic test results that reveal an idiopathic GHD are usually false positive results.
- The presence of deficiencies in three or more axes of the pituitary are strongly suggestive of a GHD. In this circumstance, testing is always optional.
- During treatment with GH, patients are supposed tobe monitored in 1 to 2 month intervals. During such monitoring, clinical assessments and evaluation of adverse effects are made to find out how the patient is responding to treatment.
- Routine cardiac testing, and measurement of lipid profiles should not be suggested against, in children with GHD.
- A diagnosis of GHD should be made without GH provocative testing especially in patients with hypothalamic pituitary defect, or deficiency of at least one other pituitary hormone.
- Spontaneous GH secretion should be suggested against, as the sole diagnostic criteria for GHD in a clinical setting.
- Patient receiving therapy for a childhood onset GHD should be retested for GHD after achieving adult height except when they have known mutations, irreversible structural damages or hormonal deficits due to embryopathic lesions.
These are not the only guidelines for growth hormone deficiency disease, but they are among the most common. They help ensure that GHD is adequately diagnosed and treated.
Natural Remedies for Growth Hormone Deficiency
Since antiquity, humanity has always strived to develop new strategies to improve health, prolong and preserve life. One of the oldest strategies is the ayurvedic medicine. This holistic type of healing was (and still is) based on the belief that health and wellness are delicately dependent on the balance between the mind, body and spirit.
Ayurvedic treatment for growth hormone deficiency incorporates a holistic approach geared towards upregulating growth hormone production and/or alleviation undesirable symptoms of growth hormone deficiency.
Ayurvedic medicine is very effective because it has little to no side effects. Some of the natural treatments used in Ayurveda include:
Ashwagandha is used to increase height because it contains minerals that increase bone density and nourish the entire skeletal system. Just two spoons of ashwagandha mixed with warm cow’s milk can be helpful for GHD when taken daily.
These are natural compounds containing calcium. Calcium generally increases bone mineralization thereby increasing bone mass.
- Rasayana therapy
Rasayana therapy restores the strength of all tissues including bones and muscle. It also helps preventing ageing of the skin, enhances memory and improves the functioning of the vital organs.
Besides ayurvedic therapy, there are other techniques that can help patients suffering from growth hormone deficiency. The idea behind these techniques is that they elevate growth hormone levels in one way or another. Each method initiates a cascade of metabolic processes which eventually leads to the stimulation of GH synthesis and release. They are very effective in deficiencies where the GH secreting cells are normal such is in secondary causes of GH deficiency. Some of these techniques include:
- Fasting intermittently
- Using arginine supplements
- Reducing your overall intake of sugar
- Exercising intensively
- Optimizing on sleep
- Taking melatonin supplements for sleep
Additionally, natural supplements that elevate growth hormone levels can help in deficiency conditions where GH production is present but reduced. A highly effective product for this management is:
- Prime HGH pills/sprays/patches and drops
This product contains the properties of the bodily GHRH which acts as a releaser for GH. It is very cost effective and can boost the production of GH by up to 500%. It is also convenient to use because it is sold as pills/sprays/patches and drops which can be conveniently administered without any worry of pain such as in injectable formulations.
Growth Hormone Deficiency in Adults’ Life Expectancy
According to Johns Hopkins Medicine news and publications, growth hormone deficiency has no significant impact on the life expectancy of an individual. The publication goes on to reveal that people with GHD due to genetic mutations will live just as long as people who produce normal amounts of the hormone.
The only factors that shortens the life span of people with GHD are the secondary effects of GHD such as cardiovascular disease.
Growth Hormone Deficiency Test and Diagnosis
Before making a diagnosis for growth hormone deficiency, your doctor will run some tests to confirm the disease. Here is how to test for growth hormone deficiency:
The diagnosis for GH deficiency is done by the GH stimulation test. In this test, a sample of blood is taken after about 10 to 12 hours of fasting. Then, the patient is given an intravenous solution that will stimulate the release of GH from the anterior pituitary.
Blood samples are then withdrawn at specific intervals and the levels of GH are tested in each sample to determine if the pituitary produced growth hormone following the stimulation.
Conversely, growth hormone excess is tested by GH suppression test. Though this is beyond the scope of this article.
Growth Hormone Deficiency Hypoglycemia
Growth hormone deficiency can lead to severe hypoglycemia. In a normal endocrine system, insulin reduces blood sugar solely. The body protects against hypoglycemia by secreting hormones that antagonize insulin such as: GH, cortisol, epinephrine, and glucagon.
Insulin is a very powerful hormone. It takes quite a number of hormones just to antagonize its effects. Therefore, a deficiency in GH will greatly impair this normal homeostasis or regulatory hormones. As a result, the patient may present with hypoglycemia.