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Human Growth Hormone Therapy for Children
with Growth Hormone Deficiency
Sean Adwar
September 24, 2007
(http://www.3dchem.com/molecules.asp?ID=272)
History of Human Growth Hormone
The anterior lobe of the pituitary gland produces growth hormone. It is required for human growth and development. Growth hormone therapy has been available for children with a deficiency in the hormone over the past four decades. Growth hormone is administered to these children to prevent short stature. The hormone is administered by injection, daily from right before puberty through around eighteen. Originally the hormone was collected from human cadavers. Unfortunately this process was time-consuming and produced very little yield resulting in extremely high priced HGH (Bajpai 2005). The switch was made to recombinant GH quickly after many recipients of pituitary derived HGH developed the deadly protein disorder, Creutzfeldt-Jakob disease. Recombinant DNA is made by splicing segments of DNA and putting them together in ways that would not naturally occur. Often this is achieved using a bacterial plasmid. This development in 1985, led to an almost endless supply of growth hormone (Lanes 2004).
http://www.painetworks.com/previewstn/hl/hl0490.html
How Growth Hormone Works
The anterior pituitary is under strict control of the hippocampus. The hippocampus releases hormones initiating the production of growth hormone from the pituitary gland. Human growth hormone is a protein of 191 amino acids that stimulates muscle and bone formation. It also increases fat metabolism. Growth hormone increases height in a variety of ways. It directly stimulates cartilage and bone formation. Growth hormone also indirectly affects growth. When growth hormone is in the bloodstream the liver produces more insulin-like growth factor 1 (Bowen 2006). IGF-1 has a stimulatory affect on osteoblast cells to increase bone growth.
Growth Hormone therapy
Childhood growth hormone deficiency is when a child has low levels of the hormone for several years resulting in short stature. The original use for supplemental growth hormone was to treat deficiency. Adding recombinant growth hormone to individuals treats the deficiency. As of now the way the hormone is administered is by an injection into muscle, most often in the thigh. The treatment must come from the referral of a pediatric endocrinologist.
Cost and Availability
While there is a large supply of human growth hormone since the invention of recombinant technology, access is still limited. Although the treatment is often covered by insurance, the cost is high for those who don’t have coverage. Per year the cost of growth hormone ranges from around ten thousand to thirty thousand dollars. This makes it difficult for many Americans without coverage to obtain growth hormone treatment.
Benefits
Of course, the overwhelming benefit of growth hormone is an increase in height. The injections are nearly painless, using extremely small needles (Bajpai 2005). For many of these children this has an immense effect on self-esteem and worth. Many shorter children are made fun of by their peers and often picked on. The sudden increase in growth relieves children from this burden.
Risks of Treatment
There are a variety of risks involved with growth hormone therapy. Possible side effects include fluid retention, joint pain, and nerve compression. All of these side effects tend to be mild. However there are beliefs that growth hormone therapy could increase the risk of diabetes and certain cancers. In one study, it was seen that there was an increase in colorectal cancer rates of adults who took growth hormone as children (http://news.bbc.co.uk/2/hi/health/2150953.stm). These results must be reexamined though since they focus on 1,848 people who took pituitary hormone taken from human cadavers, which tends to be much more dangerous than the recombinant growth hormone used almost exclusively today.
Results of Treatment
Results of growth hormone therapy have been promising. In one study, the average final height increase between those given the therapy and those who did not was 1.5-2 inches in average cases and 3.5 inches in extreme cases (Wit 1996). In the study a very low dosage was used as well. Greater results could have been seen if injections were given daily as they normally are prescribed today instead of two-four injections per week.
New Uses
With such an endless supply, over the past two decades research has led to many new uses for growth hormone. Since 1985, growth hormone therapy has been used for conditions such as: Turner syndrome, Prader-Willi syndrome and chronic renal failure. While the results have been promising they are not nearly as large as those seen when treating growth hormone deficiency. In one study the final height increase was only 5-7cm for these syndromes as oppose to increases over 10cm for patients with growth hormone deficiency (Hindmarsh 2006). It is still important to consider the costs and benefits in using growth hormone to treat these conditions. There have been few randomized studies to analyze these results. With such a high monetary cost it is important to know the exact effects before permanently initializing this treatment option (Hindmarsh 2006).
Misuse
Throughout the history of professional sports there have been people who try to circumvent the rules to enhance performance. Over the later part of the twentieth century athletes began to use anabolic steroids. These steroids, however, can be tested for in a simple urine test which most professional sports perform. However the use of human growth hormone has skyrocketed over the past ten years because of the difficulty in testing for it (Chen 2005). To test for human growth hormone a blood test needs to be administered. Currently none of the profession sports in America require a test of this sort. With results such as increase in muscle mass and decrease in fat, it is no wonder that athletes have turned to this form of cheating. For this reason growth hormone therapy has received some negative press despite its proven benefits for children
Works Cited
Bajpai, A., & Menon, P.S.N. (2005). Growth Hormone Therapy. Indian Journal of
Pediatrics 75, 139-144.
BBC News World Edition (2002). Hormone Therapy Linked to Cancer. Retrieved
September 12, 2007, from
http://news.bbc.co.uk/2/hi/health/2150953.stm
Bonds Picture.
Bowen, R. (2006). Growth Hormone. Retrieved September 15, 2007, from
http://www.vivo.colostate.edu/hbooks/pathphys/endocrine/hypopit/gh.html
Chen, S.,& Ricci, A. (2005). Recombinant Growth Hormone Administration In Athletics:
The Function, Effect, And Concerns. The Sport Supplement. 13(1).
Growth Hormone Structure Picture.
http://www.3dchem.com/molecules.asp?ID=272
Injection Photo.
http://www.painetworks.com/previewstn/hl/hl0490.html
Lanes, R (2004). Long-term Outcomes of Growth Hormone Therapy in Children and
Adolescence. Treat Endocrinol. 3(1), 53-66.
Hindmarsh, P., Dattani, M. (2006). Use of Growth Hormone in Children. Natural
Clinical Practice: Endocrinology & Metabolism, 2(5), 260-268.
Human Growth Hormone. 3Dchem.com Retrieved September 18, 2007, from
http://www.3dchem.com/molecules.asp?ID=272
Wit, J., Kamp, G., & Rikken, B. (1996). Spontaneous growth and response to growth
hormone treatment in children with growth hormone deficiency and idiopathic short stature. Pediatric Research, 39(2), 295-302.
