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HGH Deficiency in Children - Symptoms Measuring and Testing

HGH deficiency means that the pituitary gland does not make enough growth hormone. There are a number of reasons why this might occur.

Short Stature is a condition that refers to anyone who is considerably below the average height of a person of the same sex and age. This condition can occur when the individual does not produce adequate human growth hormone. HGH is produced in the pituitary gland, which can be found at the base of the brain.

Almost always the underlying cause of the HGH deficiency is unknown. It can be congenital (present at birth), or it can develop because of a medical condition or injury. A severe brain injury can also cause an HGH deficiency.

Children who have physical defects of the skull and face, such as cleft palate or cleft lip can have a pituitary gland that is poorly developed that leads to a decrease in HGH levels. Slow growth is often noticed during infancy, and it usually carries on throughout childhood. Your child's pediatrician generally will plot the growth curve of your child on a standard growth chart. The child's growth can range from no growth at all to minimal growth.

Symptoms of HGH Deficiency in Children

There are a number of symptoms that children with an HGH deficiency may experience. Let us have a look at some of the main symptoms experienced.

  • Children have a flat or slow growth rate that is usually less than two inches a year. This slow growth rate may not start until a child is 2 to 3 years of age.
  • Children with HGH deficiency are much shorter than other children that are the same gender and age.
  • Children with HGH deficiency have normal intelligence and body proportion; however, they have faces that look years younger than their actual age, and they are much more likely to have a chubby body.
  • If children are older, puberty may come later, or in some cases, it does not come at all.
  • Congenital and prenatal deficiency can reduce the male's penis size called micropenis.
  • Congenital and prenatal deficiency can cause exaggerated jaundice and hypoglycemia.
  • Growth occurs at about half the normal speed for the age.
  • Delayed physical maturation that involved bone maturation and puberty. This delay can be several years. When the HGH deficiency is present from birth and goes untreated adult height can be as short as 122 � 165 cm or 48 � 65 inches.
  • Severe human growth hormone deficiency in early childhood can cause slower muscular development that can delay gross motor milestones like walking, jumping, and standing.
  • Body composition, which is the ratio between bone, fat, and muscle, is affected in a large number of the severely deficient children.
  • Some severely deficient children have cherubic facial features that are highly recognizable. These are characterized by maxillary hypoplasia and a prominent forehead.
  • Sparse hair growth.
  • Frontal recession.
  • Pili torti is characterized by short, brittle hairs that look twisted and flattened when looked at in a microscope.
  • Trichorrhexis nodosa, which is a hair shaft defect that is characterized by weak or thickening nodes that cause the hair to easily break.

Testing for HGH Deficiency in Children

The physicians that specialize in diagnosing and treating HGH deficiency in children are called pediatric endocrinologists. Human growth hormone can be measured in a blood sample, but the testing for an HGH deficiency is hindered because the levels are almost undetectable during the day. This means that a single blood sample is no good for detecting a deficiency. Therefore, physicians use a combination of criteria � both indirect and direct � to assess an HGH deficiency, which includes:

  • Indirect hormone criteria � IGF levels from a single blood sample.
  • Auxologic criteria � this is defined by a child's body measurement.
  • Direct hormonal criteria � the HGH measurement in multiple blood samples. This will determine secretory patterns and provocative testing responses that include:

    • Samples are taken over a number of hours subnormal frequency, and amplitude of HGH secretory peaks are determined.
    • Subnormal GH secretion in relation to 2 provocative stimuli.
    • After a few days of HGH treatment increase in IGF-1 levels.
  • Response to HGH treatment.
  • Corroborative proof of pituitary dysfunction.
When there is a severe HGH deficiency, there are other measurable characteristics:
  • Proportional stature that is significantly below that anticipated for family heights. However, in the case of familial-linked HGH deficiency, this characteristic may not be present.
  • Delay in physical maturation
  • Below the normal velocity of growth
  • Delay in bone age
  • Low levels of IGF1, IGF2, IGF binding protein 3

In childhood and adulthood, the diagnosing doctor will look for these features accompanied by corroboratory evidence of hypopituitarism such as deficiency of other pituitary hormones, a structurally abnormal pituitary, or a history of damage to the pituitary. This would confirm the diagnosis; in the absence of pituitary pathology, further testing would be required.

When a provocative test is done it involves administering a dose of an agent that provokes a pituitary to release a burst of HGH. An intravenous line is used to administer the agent and then there are small amounts of blood drawn every 15 minutes for one hour. This will determine whether it provoked a rise in HGH.

There are a number of agents that can be to used to stimulate HGH production and assess stimulation:
  • Levodopa
  • Arginine
  • Epinephrine
  • Clonidine
  • Glucagon
  • Insulin
  • Propranolol

An insulin tolerance test is the test of choice because it has been shown to be age-independent and to be able to tell between normal adults and HGH deficiency.

The physician will do his/her examination, which includes height, weight, body proportion, looking for signs of a slow growth rate, where the child does not follow normal growth curves. An x-ray of the left hand can be used to determine bone age of the child. As a person grows, the bone normally changes. The x-ray can be used to follow the child's growth pattern.

The physician will run the following tests:

  • HGH causes the child's body to make IGF1 (insulin like growth factor) and IGFBP3 (insulin like growth factor binding protein 3). These growth factors can be measured.
  • Accurate HGH deficiency testing will involve a stimulation test, which will take a number of hours.
  • An MRI of the child's head, which can show the pituitary gland and hypothalamus.
  • Other tests to measure other hormone levels where HGH may not be the problem.

The sooner an HGH deficiency is treated, the more likely a child is to grow to be the average adult height. Children on average will gain four or more inches over the first year and during year two, three inches or more. The rate of growth slowly decreases. HGH replacement therapy helps the majority of children although it does not help every child. HGH injections will be administered at home once a day.

While serious side effects are rare, the most common side effects to develop include fluid retention, headache, slippage of the hip bones, muscle pain, and joint aches.

Left untreated a child may not reach their adult height. If you believe your child may suffer from an HGH deficiency, make a doctor's appointment today.

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