Why parents should watch out for growth hormone deficiency

    Dr. Eleonor Du
    Dr. Eleonor Du

    HEIGHT is an integral factor in the milestones of a child’s development. They increase in height around 12 inches in their first year, up by 5 inches in year 2, and add in 2-3 inches every year until they hit puberty. But as they grow, the noticeable height difference with their peers or siblings might be of concern. A decrease in growth rate is one of the key symptoms of growth hormone deficiency (GHD).

    GHD is an endocrine condition where the body doesn’t make enough growth hormone known as somatotropin. Symptoms may vary with age: babies with low blood sugar, boys with small penis, toddlers with noticeable poor growth and delayed puberty in adolescents.

    Parents can consult with a pedia-endocrinologist who can properly assess the underlying cause of short stature. These are doctors who specialize on diagnosis and treatment of hormone- and gland-related disorders in children.

    An initial assessment through physical examination, with medical and family history taken into consideration, determines if the child is within normal levels of growth. “Once we know that the patient is short, we have to identify whether the shortness is physiological or pathological,” as discussed by Dr. John Uy, a Pediatrician-Endocrinologist and Past President of the Philippine Society of Pediatric Metabolism and Endocrinology (PSPME).

    “Physiological short stature would include familial short stature, where the family is naturally short, and constitutional growth delay or the late bloomers – those who are small for age but eventually catch up and will be at a normal adult height. Other than these two conditions, we should consider pathological short stature and identify proportionality through an upper-lower segment ratio. Pathological disproportionate short stature is related to bone problems. If it’s pathological proportionate short stature, the doctor needs to determine if prenatal or postnatal onset.”

    Prenatal onset is attributed to one of three issues: maternal (e.g. malnutrition, alcohol use, HIV-positive), placental (decreased blood flow), or fetal (chromosome problems).

    Conditions acquired after birth such as severe asthma, cystic fibrosis, HIV, heart defect and poor nutrition can also delay a child’s growth.

    GHD can be treated with hormone replacement therapy that is administered daily using an injection pen. Dosage and duration of treatment depends on several factors such as the child’s current age and the target height. He also debunked claims that height increasing syrups readily available in the market can help achieve one’s growth potential.

    “[Treatments] are not oral because the growth hormone is [a] large protein and we give it subcutaneously.”

    Dr. Uy emphasized on the importance of early detection and treatment of GHD because it will help the patient get more height gain to catch up. “The rule of thumb is, if the patient really has growth failure and is pathological, you have to treat it as early as possible.”
    In case the child is showing any of the symptoms related to GHD, Dr. Eleonor Du, President of the PSPME, advised parents to ask for a referral from their pediatrician or family doctor.

    “We strengthen our education linkages with pediatric society and general practitioners. We recognize that they are really the ones who are in the front-lines,” she said.

    Parents may also book a consultation from one of the PSPME members. They have 27 board-certified fellows practicing in key cities and provinces around the country including Metro Manila, Batangas, Cavite, Laguna, Pangasinan, Pampanga, Cebu, Iloilo, Tacloban, and Davao.

    There is no local registry on the current numbers of patients diagnosed with GHD in the Philippines, according to Dr. Du. She mentioned that in her practice in Davao, she consults with at least 1 patient on a weekly basis.

    GHD is common among Filipinos, more than we think. “Aside from educating the parents during individual consultations, we hold advocacy lectures and tap the Department of Health and local medical societies. Pharmaceutical companies also help us with these education campaigns.”

    Global healthcare company Novo Nordisk has been actively supporting PSPME in their efforts to increase awareness about GHD. “Height is an indicator of health. So we are trying to look for avenues and ways in order to disseminate awareness for growth hormone deficiency primarily because early detection, early interference and early diagnosis is the key to overcoming this condition,” said Dr. Cyrus Pasamba, Senior Medical Manager.