Growth hormone therapy (GHT) is a prescribed medical treatment using synthetic growth hormone, nearly identical to the natural hormone produced by the pituitary gland. Administered through often daily injections, GHT is a long-term commitment. It addresses medical conditions where the body lacks sufficient growth hormone or where additional growth hormone offers therapeutic benefits.
Understanding Growth Hormone Therapy’s Purpose
Growth hormone therapy is prescribed for specific conditions in children and adults. In children, it treats growth hormone deficiency, leading to slow growth or short stature. GHT is also indicated for other conditions causing short stature, such as Turner syndrome, Prader-Willi syndrome, chronic kidney disease, Noonan syndrome, and for children born small for gestational age who do not experience catch-up growth. For these pediatric indications, the primary goal of therapy is often to improve linear growth and help children reach a more typical adult height.
In adults, GHT addresses different health concerns, focusing on adult growth hormone deficiency (AGHD). This deficiency can result from pituitary gland damage due to tumors, surgery, or radiation, or it can be a continuation of childhood growth hormone deficiency. The goals of GHT in adults include improving body composition by decreasing fat mass and increasing lean body mass, strengthening bones, enhancing exercise capacity, and improving overall quality of life. GHT is also approved for treating severe weight loss and muscle wasting associated with HIV or AIDS in adults.
Determining Cessation in Pediatric Patients
Discontinuing growth hormone therapy in pediatric patients involves evaluating several medical and physiological criteria. A primary factor is the child reaching near-final adult height, assessed by a significant slowing of growth velocity, typically less than 2 centimeters per year. This indicates that the child’s growth plates are closing or have closed, limiting further height gain.
Skeletal maturity is another determinant, assessed through bone age evaluation, usually by X-rays of the hand and wrist. Treatment generally stops when bone age reaches approximately 16 years in boys and 14 years in girls, as this signifies the fusion of growth plates. While GHT has not been shown to significantly accelerate bone age in the long term, careful monitoring remains important.
A lack of response or a plateau in growth, despite continued therapy, can also lead to stopping treatment. If a child’s height velocity falls significantly (e.g., less than 2 cm per year over baseline), healthcare providers assess adherence to therapy, IGF-1 levels, and other potential factors. The transition to adult care also involves re-evaluation, assessing the need for continued growth hormone in adulthood.
Potential side effects, such as headaches or hip issues like slipped capital femoral epiphysis, can influence the decision to discontinue or adjust therapy. Patient or parent preference, especially regarding the daily injection regimen and the long-term commitment, also plays a role in the shared decision-making process.
Determining Cessation in Adult Patients
Discontinuing growth hormone therapy in adults differs from pediatric criteria, as the goals shift from linear growth to metabolic health, body composition, and overall well-being. A primary reason for cessation is the achievement of therapeutic goals, including the normalization of insulin-like growth factor 1 (IGF-1) levels, a key indicator of growth hormone activity. Clinical improvements, such as reduced fatigue, enhanced lean body mass, and better quality of life, are also important endpoints.
If an adult patient shows a lack of clinical or biochemical response after a sufficient trial period, typically around two years, discontinuation may be considered. This applies even if IGF-1 levels are within the normal range but objective benefits are not observed. Monitoring includes regular assessment of IGF-1 levels, body composition changes, and overall clinical improvements.
The development of significant side effects or contraindications can also necessitate stopping GHT. Common side effects in adults include fluid retention, joint pain, carpal tunnel syndrome, and a mild increase in blood glucose levels. Most adverse effects may improve with dose reduction, but severe or persistent issues can lead to discontinuation.
The Discontinuation Process and Ongoing Care
Once the decision to stop growth hormone therapy is made, the process is carefully managed under medical supervision. The healthcare provider guides the patient through this transition, ensuring appropriate and safe discontinuation. While some sources suggest gradual tapering, others indicate that abrupt cessation may be possible depending on the situation.
Follow-up appointments and ongoing monitoring are important after stopping GHT to assess long-term health and address any lingering concerns or potential symptom recurrence. Monitoring may include re-evaluating body composition, metabolic parameters, and overall well-being, especially for adult patients who might experience a return of some symptoms.
Patients can expect their body to adjust to the absence of exogenous growth hormone. In some cases, previous symptoms may gradually return if the underlying deficiency persists and the body’s natural production does not compensate. For pediatric patients transitioning to adulthood, re-evaluation for adult growth hormone deficiency is common, and some may require continued, albeit lower, doses in adulthood.