Box 7.25Treatment of poor growth*

Medical
DrugUseAdvantagesDisadvantages/side effects
Growth hormoneGrowth hormone deficiency For childrenHuman recombinant GH available from several manufacturersSingle daily subcutaneous injection usually at night
Regarded as expensive
For childrenDose calculated according to body surface area or body weight. Auxological monitoringThrotrophin deficiency may be ‘unmasked’. ~10% may develop GH antibodies
For adultsDose titrated against assays of serum IGF-1 and/or IGF-BP3. Mean dose ~0.5 mg/dRarely fluid retention. Benign intracranial hypertension. Higher doses needed in women. Potential risk of increase in malignancy rates
GHRH e.g. somatorelinImprove endogenous GH secretionAdvantages over GH to be establishedDaily subcutaneous injections
Expensive
IGF-1Treatment of GH insensitivityRecombinant IGF-1 as ‘orphan drug’Not commercially viable.
Daily subcutaneous injection.Hypoglycemia, edema, Hyperandrogenism. Does not normalize growth (indicating the importance of GH acting directly)
Improves growth and other aspects of the condition
OxandroloneConstitutional delayOrally active. Effective without reducing final heightFew side effects in low dose used
Surgical
ProcedureUseAdvantagesDisadvantages/side effects
Leg lengthening +Increase final height~5 cm increase in final heightPainful, slow, expensive and prone to complications
*

The treatment of other medical conditions leading to poor growth (Box 7.13) requires other treatments not given here.

+

Requires the patient to be at final height and extremely motivated.

From: Chapter 7, The pituitary gland

Cover of Endocrinology
Endocrinology: An Integrated Approach.
Nussey S, Whitehead S.
Copyright © 2001, BIOS Scientific Publishers Limited.

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