Growth Hormone Treatment

• Deficiency Treatment
• Excess Treatment

Deficiency Treatment

Today people with a growth hormone deficiency are treated with synthetic growth hormone, which is manufactured using recombinant DNA:

• somatropin [rDNA origin] (brand names Genotropin, Humatrope, Norditropin, Nutropin, Omnitrope, Saizen, Serostim, Tev-Tropin, and Zorbitive)

Before the manufacture of synthetic growth hormone, the only source of growth hormone was human cadaver pituitary glands. This product was withdrawn from the market in 1985 when it was linked to Creutzfeldt-Jakob disease (a rare and incurable degenerative brain disease). Fortunately, synthetic human growth hormone was available by then and continues to be used today.

During growth hormone treatment, a person's dosage needs to be evaluated and adjusted regularly. Short-term growth hormone treatment is generally considered to be safe. Long-term use requires continued monitoring for possible side effects and irregular hormone levels. Children typically stop growth hormone treatment when their bones fuse.

Many medications have side effects, some of which are serious and others are not. People who experience severe or intolerable side effects should notify their health care provider. Additional information, side effects, and drug interactions can be obtained by clicking the name of the highlighted medications. It's important for people to ask their healthcare provider or pharmacist in advance for possible drug side effects or interactions.

Approved Uses

• Adult growth hormone deficiency (including hypopituitarism)
  
• AIDS wasting
  
• Childhood growth hormone deficiency (including pituitary dwarfism and childhood hypopituitarism)
  
• Adult growth hormone deficiency (including hypopituitarism)
  
• AIDS wasting
  
• Childhood growth hormone deficiency (including pituitary dwarfism and childhood hypopituitarism)
  
• Chronic renal insufficiency (children whose height is less than the third percentile for their chronologic age)
  
• Idiopathic short stature (children with height standard deviation scores of -2.25 or lower)
  
• Noonan syndrome
• Prader-Willi syndrome
  
• Short bowel syndrome (to lessen the requirement for intravenous nutrition)
  
• Small-for-gestational age (children who fail to exhibit catch-up growth by age 2)
  
• Turner syndrome

Proposed Conditions

Unapproved Uses

Numerous research studies are being conducted to investigate additional uses for growth hormone. Promising results are sent to the FDA for its approval. When the FDA is satisfied that a claim is justified and the treatment is safe, the FDA expands its list of approved conditions. There currently are no FDA-approved growth hormone treatments for the following conditions and its use for these conditions is considered investigational:

• Anti-aging
  A person's growth hormone levels normally decrease as people age, leading many to suspect that growth hormone treatments will improve the health and fitness of older adults. Anti-aging has become a popular research area for growth hormone treatments. Although the results of these studies are not final and the FDA has not approved growth hormone for this use, numerous older adults take growth hormone as an anti-aging treatment. According to the National Institute on Aging (NIA), a component of the Federal Government's National Institutes, recommendations to use growth hormone to improve the aging process and health problems associated with aging should be viewed with skepticism until the results of these studies are available.
• Children of short stature
  Some parents consider shortness a disadvantage and want their children treated with growth hormone even though their children do not meet the FDA's guidelines for treatment. Currently, the FDA only approves growth hormone treatment for children with height standard deviation scores of -2.25 or lower. Growth hormone treatment for healthy short children is controversial. The National Organization of Short Statured Adults is opposed to the use of human growth hormone for short but otherwise healthy children.
• Athletes and bodybuilders
  Growth hormone has little effect on muscle strength or function. Growth hormone does, however, increase muscle mass, decrease body fat, and improve performance. As a result, some athletes and bodybuilders take growth hormone illegally for this purpose, and may combine growth hormone with anabolic steroids or insulin to enhance the appearance of their muscles. The non-medical use of anabolic steroids, insulin, and growth hormone for these purposes has serious health risks, including liver damage and diabetes.
• Dietary supplement
  Although growth hormone cannot be sold as a dietary supplement, some Web sites illegally distribute human growth hormone without prescription. Moreover, some Web sites sell counterfeit (fake) human growth hormone drugs. The National Association of Boards of Pharmacy (NABP) created the Verified Internet Pharmacy Practice Sites (VIPPS®) program, which gives a seal of approval to those sites that are appropriately licensed, are legitimately operating via the Internet, and that have successfully completed a rigorous criteria review and inspection. For a list of pharmacies that carry the VIPPS seal, see http://www.vipps.info.

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Excess Treatment

The most common cause of an excessive production of growth hormone is a slow-growing, noncancerous tumor of the anterior lobe of the pituitary gland, which results in tall stature. The two associated conditions are:

• Pituitary gigantism occurs when the overproduction of growth hormone occurs before the bones stop growing lengthwise.
• Acromegaly occurs when the overproduction of growth hormone occurs after the bones have stopped growing.

The following treatments for pituitary gigantism and acromegaly are designed to reduce a person's growth hormone levels:

Surgery

Radiation

Prescription Medications

• somatostatin analogs
  These medications inhibit growth hormone and insulin-like growth factor (IGF) secretion.
  • octreotide injection (brand name: Sandostatin)
    
• growth hormone antagonists
  These medications block the effects of growth hormone.
  • pegvisomant (Somavert)
    
• dopamine-receptor agonists
  These medications decrease growth hormone secretion.
  • cabergoline (Dostinex)