Growth Hormone Deficiency
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Introduction
Decreased growth hormone is trouble
The Case of...
a simple case introducing clincial presentation and calling for a differential diagnosis. To get students thinking.
Causes and Risk Factors
Congenital GH deficiency can be:
- idiopathic
Acquired GH deficiency:
- tumours (craniopharyngioma)
- trauma
- cranial infection
- irradiation
- post-operative
Pathophysiology
GH is important for chondrocyte proliferation and IGF-1 release. GH has little impact on fetal growth, as maternal and placental factors are more important.
IGF-1 acts on the liver and long bones.
Signs and Symptoms
- history
- physical exam
History
Impaired QoL
- Increased WHR and total body fat
- impaired cardiac function and muscle mass
- decreased fibrinolytic activity
- increased cholesterol
- abdominal obesity
- insulin resistance
high-pitched voice
Physical Exam
Short, chubby infants
delayed puberty
- boys can have micropenis and undescended testes
Investigations
- lab investigations
- diagnostic imaging
Lab Investigations
hypoglycemia
GH stimulation testing if strong indication
- give arginine, insulin, dopamine, or propanolol
- +ve test if GH does not sufficiently rise
Diagnostic Imaging
Differential Diagnosis
Other causes of short stature should be strongly considered, as true GH deficiency is quite rare.
Treatments
GH replacement if GH is proven to be deficient, if epiphyses are unfused, and...
Consequences and Course
Additional Resources
Topic Development
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