Approach to the patient: Safety of Growth Hormone Replacement in Children and Adolescents

Author(s):  
Vaneeta Bamba ◽  
Roopa Kanakatti Shankar

Abstract The use of recombinant human growth hormone (rhGH) in children and adolescents has expanded since its initial approval to treat patients with severe GH deficiency (GHD) in 1985. rhGH is now approved to treat several conditions associated with poor growth and short stature. Recent studies have raised concerns that treatment during childhood may impact morbidity and mortality in adulthood, with specific controversies over cancer risk and cerebrovascular events. We will review three common referrals to a pediatric endocrinology clinic, followed by a summary of short and long term effects of rhGH beyond height outcomes. Methods to mitigate risk will be reviewed. Finally, this information will be applied to each clinical case, highlighting differences in counseling and clinical outcomes. rhGH therapy has been used for over three decades. Data are largely reassuring, yet we still have much to learn about pharmaceutical approaches to growth in children and the lifelong impact of treatment.

SLEEP ◽  
2020 ◽  
Vol 43 (Supplement_1) ◽  
pp. A335-A336
Author(s):  
R Nasser ◽  
T Vervloet ◽  
C A Eckley ◽  
S Amade ◽  
V Dokkedal-Silva ◽  
...  

Abstract Introduction Recombinant human Growth Hormone (rhGH) is an important pharmacological agent for linear growth stimulation and body composition in children with growth hormone deficiency (GHD). However, reports indicate that treatment with rhGH can be associated with adeno-tonsillar hyperplasia. This condition can lead to occurrence of obstructive sleep apnea (OSA) and worsening of sleep and life quality. Nonetheless, studies assessing this outcome in non-syndromic children are scarce. Methods We evaluated the difference in size of pharyngeal and palatine tonsils in patients aged between 5 and 17 being treated with recombinant human Growth Hormone (rhGH). We conducted a prospective longitudinal observational study. Twelve patients in treatment with rhGH were evaluated by otorhinolaryngological physical examination, nasofibrolaryngoscopy and obstructive sleep apnea (OSA)-18 questionnaire in two different time-points: when selected (T0) and after 6 months (T1). Results No significant associations were found regarding palatine and pharyngeal tonsil size with rhGH treatment. In relation to OSA 18 questionnaires, there was no statistically significant result in the absence of covariables for the general score as well as for the five domains that it comprises. When covariables were included in the analyses, controlled by the patients age, we observed statistically significant increases in the general score and in the domains relating to sleep disorders, emotional suffering, diurnal problems and the caretaker′s concerns. Conclusion In the present study, pharyngeal or palatine tonsils hyperplasia were infrequent during treatment with rhGH in the non-syndromic children and adolescents. However, the impact on sleep and quality of life that may arise warrant careful monitoring during therapy. Support Associação Fundo de Incentivo à Pesquisa (AFIP).


2010 ◽  
Vol 100 (2) ◽  
pp. 321-322 ◽  
Author(s):  
Takafumi Taguchi ◽  
Toshihiro Takao ◽  
Yasumasa Iwasaki ◽  
Kyonghon Pooh ◽  
Mizuho Okazaki ◽  
...  

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