HOW DOCTORS CHECK FOR GROWTH AND HORMONE DISORDERS

Normal growth is the result of many factors, including nutrition, genetics, and hormones. If your child’s doctor has concerns about your child's growth, he or she may refer you to a pediatric endocrinologist. This is a doctor who specializes in growth and hormone problems.

The specialist may order further tests. Examples of some of these tests are provided below. Remember that each patient is different and only your doctor can decide which tests—if any—are needed.

Most likely, the doctor will start with a review of your child's and your family’s medical history. He or she may also review your child's growth chart and complete a full physical examination.

To help gain a better picture, he or she may also order blood and lab tests. These can be used to rule out possible medical conditions that can cause poor growth.

If the doctor suspects that your child is not making enough growth hormone, he or she may also do a growth hormone stimulation test, also called a stim test.

What to expect if your doctor recommends a stim test for your child:

An intravenous (IV) needle will be placed into your child's arm or hand. This helps the doctor or nurse to collect more than one blood sample with only one needle prick
A medicine will be given to your child through the IV to help your child's body release growth hormone
Blood samples will also be taken from this IV at different times over a few hours
After the test, the blood samples will be sent to a laboratory to determine if your child's body produced the expected amount of growth hormone
The doctor or nurse can tell you about any possible side effects of the test. For example, your child may feel tired and want to rest after the test

There are other types of tests the doctor may do:

Bone-age x-ray of your child's hand and wrist. This is used to see if his or her bone growth is delayed or advanced compared with other children
Genetic tests to identify hereditary diseases affecting growth
MRI scan (or CT scan) that shows an image of the pituitary gland to evaluate any changes

These tests can help pinpoint the causes of slow growth in children.

If you have concerns about your child's growth, talk to your pediatrician about it. The sooner your child is evaluated, the sooner you can begin a treatment plan.

For adults:

While adults may not grow in the same ways as children, hormones affect how we develop throughout our lives. Together, growth hormone (GH) and an associated protein, insulin-like growth factor I (IGF-I), help keep our bodies in a normal state by promoting growth and development. GH and IGF-I impact many aspects of adult wellness, including bone health, metabolism, and organ growth.

If you are an adult who is concerned about your development, speak with your doctor to determine what steps to take next.

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Understanding and CHARTINGGROWTH

This site is intended only for U.S. residents. The products discussed in this site may have different product labeling in different countries. The information provided is for educational purposes only and is not intended to replace discussions with a healthcare provider.

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Important Safety Information & Indications

Growth hormone should not be used to increase height in children after the growth plates have closed.

Growth hormone should not be used in patients with diabetes who have certain types of diabetic retinopathy (eye problems).

Growth hormone should not be used in patients who have been recently diagnosed with cancer, with cancer, or who are being treated for cancer. Growth hormone deficiency can be caused by brain tumors. So, the presence of these brain tumors should be ruled out before treatment is started. Growth hormone should not be used if it is shown that a previous brain tumor has come back or is getting larger.

Growth hormone should not be used in patients who are critically ill because of surgery, trauma, or respiratory failure.

Growth hormone should not be used in children with Prader-Willi syndrome who are very overweight or have severe breathing problems.

GENOTROPIN should not be used by patients who have had an allergy or bad reaction to somatropin or any of the other ingredients in GENOTROPIN. In the event of an allergic reaction, seek prompt medical attention.

Some patients have developed diabetes mellitus while taking GENOTROPIN. Dosage of diabetes medicines may need to be adjusted during growth hormone treatment. Patients should be watched carefully if growth hormone is given along with glucocorticoid therapy and/or other drugs that are processed by the body in the same way.

In childhood cancer survivors, treatment with growth hormone may increase the risk of a new tumor, particularly certain benign brain tumors. This risk may be higher in patients who were treated with cranial radiation. Also, patients and their doctors should check regularly for skin changes.

A small number of patients treated with growth hormone have had increased pressure in the brain. This can cause headaches and problems with vision. Treatment should be stopped and reassessed in these patients. Patients with Turner syndrome and Prader-Willi syndrome may be at higher risk of developing increased pressure in the brain.

Thyroid function should be checked regularly during growth hormone therapy. Thyroid hormone replacement therapy should be started or adjusted if needed.

Patients treated with growth hormone should be checked regularly for low serum cortisol levels and/or the need to increase the dose of the glucocorticoids they are taking.

In children experiencing rapid growth, curvature of the spine may develop or worsen. This is also called scoliosis. Patients with scoliosis should be checked regularly to make sure their scoliosis does not get worse during their growth hormone therapy.

In children experiencing rapid growth, limping or hip or knee pain may occur. If a child getting growth hormone therapy starts to limp or gets hip or knee pain, the child’s doctor should be notified and the child should be examined.

Growth hormone should only be used during pregnancy if clearly needed. It should be used with caution in nursing mothers because it is not known whether growth hormone is passed into human milk.

Use a different place on the body each day for growth hormone injections. This can help to prevent skin problems such as lumpiness or soreness.

Some cases of pancreatitis (inflamed pancreas) have been reported rarely in children and adults receiving growth hormone. There is some evidence that there is a greater risk of this in children than in adults. Literature suggests that girls who have Turner syndrome may have a greater risk of pancreatitis than other children taking growth hormone. In any child who develops lasting, severe abdominal pain, pancreatitis should be considered.

In studies of GENOTROPIN in children with GHD, side effects included injection site reactions, such as pain, redness/swelling, inflammation, bleeding, scarring, lumps, or rash. Other side effects were fat loss, headache, blood in the urine, low thyroid activity, and mildly increased blood sugar.

In studies of GENOTROPIN in children born SGA, side effects included temporarily elevated blood sugar, increased pressure in the brain, early puberty, abnormal jaw growth, injection site reactions, growth of moles, and worsening of scoliosis (curvature of the spine).

Deaths have been reported with the use of growth hormone in children with Prader-Willi syndrome. These children were extremely overweight, had breathing problems, and/or lung infection. All patients with Prader-Willi syndrome should be examined for these problems. They should also establish healthy weight control.

In studies of GENOTROPIN in children with PWS, side effects included fluid retention, aggressiveness, joint and muscle pain, hair loss, headache, and increased pressure in the brain.

Turner syndrome patients taking growth hormone therapy may be more likely to get ear infections. This is also called otitis media.

In studies of GENOTROPIN in children with Turner syndrome, side effects included flu, throat, ear, or sinus infection, runny nose, joint pain, and urinary tract infection.

In studies of GENOTROPIN in children with ISS, side effects included respiratory illnesses, flu, throat infection, inflammation of the nose and throat, stomach pain, headaches, increased appetite, fever, fracture, mood changes, and joint pain.

Women who are taking estrogen by mouth may take GENOTROPIN. They may need a larger dose of growth hormone.

GENOTROPIN may be taken by the elderly when appropriate. Elderly patients may be more likely to have side effects with growth hormone therapy.

In studies of GENOTROPIN in adults with GHD, side effects included fluid retention, joint or muscle pain, stiffness, and changes in sensation. Usually these side effects did not last long and depended on the dose of GENOTROPIN being taken.

GENOTROPIN cartridges contain m-Cresol and should not be used by patients allergic to it.

A health care provider will help you with the first injection. He or she will also train you on how to inject GENOTROPIN.

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INDICATIONS

GENOTROPIN is a prescription product for the treatment of growth failure in children:

Who do not make enough growth hormone on their own. This condition is called growth hormone deficiency (GHD)
With a genetic condition called Prader-Willi syndrome (PWS). Growth hormone is not right for all children with PWS. Check with your doctor
Who were born smaller than most other babies born after the same number of weeks of pregnancy. Some of these babies may not show catch-up growth by age 2 years. This condition is called small for gestational age (SGA)
With a genetic condition called Turner syndrome (TS)
With idiopathic short stature (ISS), which means that they are shorter than 98.8% of other children of the same age and sex; they are growing at a rate that is not likely to allow them to reach normal adult height and their growth plates have not closed. Other causes of short height should be ruled out. ISS has no known cause

GENOTROPIN is a prescription product for the replacement of growth hormone in adults with growth hormone deficiency (GHD) that started either in childhood or as an adult. Your doctor should do tests to be sure you have GHD, as appropriate.

You are encouraged to report negative side effects of prescription drugs to the FDA. Visit http://www.fda.gov/MedWatch or call 1-800-FDA-1088.

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