 Growth hormone (somatotropin) is an organic compound that stimulates the growth of bone, cartilage, and tissue. It also influences the metabolism (break down) of proteins, carbohydrates, and fat. Growth hormone is one of several hormones produced by the anterior (front) lobe of the pituitary gland, which is located at the base of the brain. Children need growth hormone to grow normally. Although an adult's bones have stopped growing lengthwise, adults continue to need growth hormone to maintain their bones, muscles, and body fat, as well as maintain their strength, energy, and quality of life. Various medical conditions occur when the body produces too much or too little growth hormone. These conditions are caused by gene mutations, pituitary gland damage (due to tumor, radiation, trauma, or surgery), or problems with the hypothalamus (which controls the pituitary gland). Growth hormone excess can lead to tall stature in children or enlarged features and thickened skin in adults. Growth hormone deficiency can lead to short stature in children or decreased muscle mass and weakness in adults. People with growth hormone excess or deficiency will typically be referred to a specialist called an endocrinologist. The endocrinologist will properly diagnose growth hormone levels in their patients and monitor their treatment accordingly. People diagnosed with excess growth hormone usually suffer from either pituitary gigantism or acromegaly. These conditions are typically caused by a slow-growing, noncancerous tumor located in the pituitary gland and result in tall stature. Treatment options include surgical removal of the tumor (up to 80% cure rate), radiation, and prescription medications. The medications work by either reducing the levels of growth hormone or by blocking the effects of growth hormone. Examples of medications to treat growth hormone excess include the following:
• octreotide injection (brand name Sandostatin)
• pegvisomant (Somavert)
• cabergoline (Dostinex) People with deficiencies requiring growth hormone treatment are prescribed a synthetic (man-made) drug. The drugs work identical to the way the body's naturally occurring growth hormone works. These medications require prescriptions and are given by injection. Examples of medications to treat growth hormone deficiency include the following:
• somatropin (brand names Genotropin, Humatrope, Norditropin, Omnitrope, Saizen, Serostim, Tev-Tropin, Zorbitive, Nutropin and Nutropin AQ)
• somatrem (Protropin) FDA (Food and Drug Administration)-approved conditions for treatment with somatropin:
• Adult growth hormone deficiency (including hypopituitarism)
Genotropin, Humatrope, Norditropin, Nutropin and Nutropin AQ, Omnitrope, Saizen, Tev-Tropin
• AIDS wasting
Saizen, Serostim
• Childhood growth hormone deficiency (including pituitary dwarfism and childhood hypopituitarism)
Genotropin, Humatrope, Norditropin, Nutropin and Nutropin AQ, Omnitrope, Saizen, Tev-Tropin
• Chronic renal insufficiency (in children whose height is less than the third percentile for their chronologic age)
Nutropin and Nutropin AQ
• Idiopathic short stature (children with height standard deviation scores of -2.25 or lower)
Humatrope
• Pituitary dwarfism
Humatrope
• Prader-Willi syndrome
Genotropin
• Short bowel syndrome (to lessen the requirement for intravenous nutrition)
Zorbitive
• Small-for-gestational age (children who fail to exhibit catch-up growth by age 2)
Genotropin
• Turner syndrome
Humatrope, Nutropin, Nutropin AQ FDA-approved conditions for treatment with somatrem:
• Adult growth hormone deficiency (including hypopituitarism)
• Childhood growth hormone deficiency (including pituitary dwarfism and childhood hypopituitarism)
• Chronic renal insufficiency
• Decreased body growth (Down syndrome and juvenile chronic arthritis)
• Diabetic foot ulcer
• Idiopathic short stature
• Pituitary dwarfism
• Turner syndrome
Numerous research studies are being conducted to investigate additional uses for growth hormone. There currently are no FDA-approved growth hormone treatments for the following conditions, where its use 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. 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. Additional conditions
Growth hormone is being studied to treat cystic fibrosis, obesity and severe burns. It is also being studied to counteract muscle-wasting conditions due to surgery, trauma, cancer, and long-term hemodialysis. Because growth hormone wasn't marketed as a dietary supplement or food before the FDA approved it as a drug, growth hormone cannot be sold as a dietary supplement. Federal law prohibits the distribution of growth hormone outside a legitimate doctor-patient relationship. Not only do some Web sites illegally distribute human growth hormone without a prescription, some sites even sell counterfeit (fake) growth hormone drugs. However, you can choose to fill your online prescription orders with a pharmacy that carries the Verified Internet Pharmacy Practice Sites (VIPPS®) seal of approval. For a list of pharmacies that carry the VIPPS® seal, see http://www.vipps.info. Treatment with synthetic (recombinant) human growth hormone is generally considered to be safe. However, the safety and effectiveness of growth hormone has not been established for pediatric patients with AIDS or short bowel syndrome. Be sure to notify your doctor if you experience any side effects that become bothersome or severe. You and your doctor can work together to determine the right treatment for you based on your particular symptoms and pattern of disease. Sources:
Drug Facts and Comparisons, Facts & Comparisons, 2006.Drugs and Supplements, "Growth Hormone (Parenteral Route)." http://www.mayoclinic.com. Mayo Clinic Health. Last accessed 3/21/2007.
Growth Disorders, "Growth Hormone Issues in Children and Adults." http://www.hormone.org. The Hormone Foundation. Last accessed 3/21/2007.
Hormonal Disorders, "Pituitary Gland Disorders." http://www.merck.com/mmhe. The Merck Manual of Medical Information, 2nd Home Edition, online version. Last accessed 3/21/2007.
Medical Encyclopedia. http://www.nlm.nih.gov/medlineplus. Medline Plus. Last accessed 3/21/2007.
Micromedex® Healthcare Series. Thomson Micromedex, 2006. Last accessed 3/21/2007.
U.S. Food and Drug Administration, http://www.fda.gov. Last accessed 3/21/2007.
"Verified Internet Pharmacy Practice Sites™ (VIPPS®) Frequently Asked Questions." http://www.nabp.net. Last accessed 3/21/2007.
This answer prepared 3/21/2007.
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