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Is growth hormone therapy safe for children?

Growth hormone therapy is a safe and effective treatment for children with growth hormone deficiency and other growth disorders causing short stature.
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Significant side effects of growth hormone therapy may include headaches, nausea and vomiting, joint pain, and swelling in the hands and feet (oedema). However, these are very rare.16 If they do happen, your child’s doctor or nurse should be informed.
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The most frequent side effects are skin reactions at the site of injection, such as pain, redness, swelling, itching and bruising.45 Repeated injections at the same site may cause lipoatrophy – a large deep depression or dimple as a result of damage to the underlying fatty tissue. To prevent this, rotate the injection sites for each injection so that the skin has time to heal properly.46

Why isn’t growth hormone therapy recommended for idiopathic short stature?

The effectiveness of growth hormone therapy for idiopathic short stature (ISS) is controversial. Many doctors are divided as to whether children with ISS would benefit from growth hormone therapy.47 The response to treatment in children with ISS is highly variable, and those who do respond to treatment may only have modest gains in height (by an average of 4–6 cm only).27,48

Growth hormone therapy is expensive and works slowly over several years. The potential gains in height will need to be weighed against the considerable cost of treatment, which may exceed SGD 30,000 per year depending on dosage levels. For a 30-kg child, the estimated cost is ~SGD 23,000 per 1 cm increase in height.48

If your child doesn’t qualify for growth hormone therapy, discuss your child’s options with your doctor. For some children, a growth plan focusing on lifestyle habits (healthy eating, sleeping and physical activity) does help. Others may require special interventions. Your doctor will be the best resource to answer your questions.

Is there a treatment that does not require injections?

Somatropin is a protein molecule that is easily destroyed by stomach acids. As such, it has to be given by injection rather than by mouth. Scientists are working hard to develop new forms of somatropin that can be swallowed in a capsule, absorbed through an implant or skin patch, inhaled into the lungs using an aerosol spray, or sprayed into the nose.49,50 These delivery systems are at various stages of research and are not yet available in the market.

How can I help my child feel comfortable with growth hormone injections?

If your child has needle anxiety or complains of injection pain, ask your doctor about automatic injection pens, hidden-needle or needle-free devices with noiseless operations, or those with finer injection needles and adjustable injection speeds.51,52 If you keep the growth hormone medication in the refrigerator, take it out and let it warm to room temperature. This helps prevent pain from injecting a cold solution.53
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Alternatively, try these strategies to reduce needle-related pain or distress. Coach and your child to take slow deep relaxing breaths during the injection if he or she is feeling tense. Use distraction techniques (watching a cartoon, listening to music, playing video games) if needed.54 Choose an injection site that has extra fat – abdomen injections are reported to be less painful than thigh injections.53 However, avoid giving multiple injections to the same spot as this can be painful and cause unsightly skin changes!

How tall will my child grow with growth hormone therapy?

Not all children respond to growth hormone therapy the same way ‒ some undergo rapid growth while others see very little changes in height. How much extra height a child will gain with growth hormone therapy will depend on the diagnosis and severity of the underlying condition, how early the treatment was started, and for how long the child remained on growth hormone therapy.53 Your doctor will monitor your child’s response to growth hormone therapy and advise you on what to expect based on your child’s unique situation.

When can my child stop growth hormone therapy?

Growth hormone is generally continued until your child has reached his or her full height potential and growth has slowed down to less than 2 cm in one year.15 This is when the bones have fully matured (indicated by the closure of growth plates) at the bone ends and additional gains in height is no longer possible. On the other hand, your doctor may recommend discontinuing treatment early if your child had poor response to growth hormone therapy in the first year of treatment.15 The decision whether to stop growth hormone therapy should be jointly made with your doctor.

REFERENCES 

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32. Rohrer TR, et al. Growth hormone delivery devices: current features and potential for enhanced  treatment adherence. Expert Opin Drug Deliv. 2017;14:1253-64. 

33. MIMS. SciTropin A. Consumer Medicine Information. December 2020. Available at:  https://www.nps.org.au/assets/medicines/83d30dcb-1f14-4d49-836b-a53300ff22d1.pdf.  Accessed 29 July 2022. 

34. Press Release. SciGen receives approval from Australian Register of Therapeutic Goods, for  Nemera’s reusable pen injector, for its human growth hormone. 17 March 2022. Available at: https://www.nemera.net/wp-content/uploads/2022/03/SciGen_Nemera_press-release_march 2022-1.pdf. Accessed 29 July 2022. 

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38. Zhou Y, et al. Sleep duration and growth outcomes across the first two years of life in the  GUSTO study. Sleep Medicine. 2015;16:1281-6. 

39. Kim TW, et al. The impact of sleep and circadian disturbance on hormones and metabolism. Int J  Endocrinol. 2015;2015:591729. 

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41. Wideman L, et al. Growth hormone release during acute and chronic aerobic and resistance  exercise: recent findings. Sports Med. 2002;32:987-1004. 

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43. Ministry of Health Singapore. Subsidies for services and drugs at public healthcare settings.  Updated 12 July 2021. Available at: https://www.moh.gov.sg/cost-financing/healthcare schemes-subsidies/subsidies-for-services-and-drugs-at-public-healthcare-settings. Accessed 25  July 2022. 

44. Ministry of Health Singapore. Drug subsidies and schemes. Updated 22 July 2022. Available at:  https://www.moh.gov.sg/cost-financing/healthcare-schemes-subsidies/drug-subsidies schemes. Accessed 25 July 2022.  

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46. Chhiba PD, et al. Lipoatrophy associate with daily growth hormone injections. Endocrinol  Diabetes Metab Case Rep. 2021;2021:21-0087. 

47. Frindik JP, et al. Managing idiopathic short stature: role of somatropin (rDNA origin) for  injection. Biologics. 2010;4:147-55.  

48. Loke KY. Making $ense of growth hormone therapy for normal short children. Ann Acad Med  Singap. 2005;34:657-3. 

49. Cazares-Delgadillo J, et al. Human growth hormone: new delivery systems, alternative routes of  administration, and their pharmacological relevance. Eur J Pharm Biopharm. 2011;78:278-88.

50. Ghasemi R, et al. mPEG-PLA and PLA-PEG-PLA nanoparticles as new carriers for delivery of  recombinant human Growth Hormone (rhGH). Sci Rep. 2018;8:9854. 

51. Main KM, et al. Automatic needle insertion diminishes pain during growth hormone injection.  Acta Paediatr. 1995;84:331-4. 

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