Growth Failure in Children (cont.)
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Growth hormone (somatotropin) is used to replace the body's lack of growth hormone. It is also used as a growth-promoting agent in certain conditions. Growth hormone, also known as somatropin (Nutropin, Genotropin, Humatrope, Norditropin, Saizen, Tev-Tropin, Omnitrope), is used to treat growth hormone deficiency. Usually, a significant increase in growth velocity occurs with therapy. During the first year, an average of about 4 inches (10-11 cm) per year occurs in growth in children with growth hormone deficiency and an average of 7-9 cm per year in growth occurs in children with other disorders. This drug is typically given as a daily injection underneath the fat of the skin, although clinical studies are underway that are examining preparations of growth hormone that would be injected only once weekly.
The U.S. Food and Drug Administration (FDA) has approved the use of growth hormone for promoting growth in children with Turner Syndrome (1996), Prader-Willi Syndrome (2000), Noonan Syndrome (2007), and children who were small for gestational age but have not caught up with their growth (2002). The FDA has also approved the use of growth hormone for what has been termed idiopathic short stature (ISS) (2003). Children with ISS are very short (height is less than or equal to the 1.2 percentile), are not growth hormone deficient, are not likely to finish their growth with a height in the normal range (meaning an adult height of less than 4' 11" for women and less than 5' 3" for men), and do not have a specific cause identified for their short stature.
In 2005, Insulin-like Growth Factor I was approved by the FDA for treatment of severe Growth Hormone Insensitivity Syndrome. This syndrome is usually caused by an abnormality in the growth hormone receptor and is very rare (there are probably no more than 500 people in the world with this condition). This medication is marketed under the name Increlex and is given as a once- or twice-daily injection. There has been some interest in studying whether this medication might be helpful in other situations in which growth hormone has been ineffective.
Androgens may be prescribed for children with Turner syndrome. Oxandrolone acetate (Oxandrin) is a synthetic testosterone derivative used to potentiate the growth-promoting effect of growth hormone.
Stephen Kemp, MD, PhD
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