Management of growth hormone deficiency (GHD) in children involves a comprehensive approach starting with accurate diagnosis, followed by individualized growth hormone (GH) replacement therapy and multidisciplinary care.
Diagnosis should be confirmed by endocrinology specialists using clinical assessment, auxological data, and biochemical testing including GH stimulation tests and measurement of insulin-like growth factor-I (IGF-I) levels to establish deficiency Grimberg et al. 2016. Genetic testing may be considered in some cases to identify underlying causes Collett-Solberg et al. 2019.
Once diagnosed, GH therapy is initiated with recombinant human growth hormone, tailored to the child's weight and clinical response, aiming to normalize growth velocity and improve final adult height Grimberg et al. 2016. Treatment requires regular monitoring of growth parameters, IGF-I levels, and potential side effects, with dose adjustments as needed Miller et al. 2024.
Multidisciplinary involvement is essential, including paediatric endocrinologists, dietitians, and psychological support to address the child's overall health and well-being Collett-Solberg et al. 2019. Coordination with primary care teams ensures continuity and support for families.
Emerging therapies such as long-acting GH analogues (e.g., somapacitan) offer potential benefits in reducing injection frequency and improving adherence, though their use should be guided by specialist advice and current evidence Miller et al. 2024.
In summary, current guidelines recommend specialist diagnosis, individualized GH replacement therapy with ongoing monitoring, and multidisciplinary care to optimize outcomes in children with GHD NICE NG243 Grimberg et al. 2016Collett-Solberg et al. 2019Miller et al. 2024.
Key References
- NG243 - Adrenal insufficiency: identification and management
- NG75 - Faltering growth: recognition and management of faltering growth in children
- NG18 - Diabetes (type 1 and type 2) in children and young people: diagnosis and management
- (Grimberg et al., 2016): Guidelines for Growth Hormone and Insulin-Like Growth Factor-I Treatment in Children and Adolescents: Growth Hormone Deficiency, Idiopathic Short Stature, and Primary Insulin-Like Growth Factor-I Deficiency.
- (Collett-Solberg et al., 2019): Diagnosis, Genetics, and Therapy of Short Stature in Children: A Growth Hormone Research Society International Perspective.
- (Miller et al., 2024): Developments in the Management of Growth Hormone Deficiency: Clinical Utility of Somapacitan.