Early Signs of Growth Hormone Deficiency and How It Impacts Indian Children
When it comes to children, all that the parents want is healthy growth and development. However, some inherited and acquired conditions can result in impairment of growth. Identifying the early symptoms of restricted growth can lead to early intervention and better growth.”
Growth Hormone is an important chemical that plays a crucial role in a child’s overall health and development. Growth hormone promotes significant growth in bone and cartilage, leading to increased height, while it also influences muscle mass and body composition by increasing lean muscle mass and decreasing fat mass. Growth Hormone Deficiency (GHD) is a medical condition where the pituitary gland (a small endocrine gland in the brain) fails to produce enough growth hormone, leading to stunted physical development. While genetic, nutritional, and environmental factors can influence the growth of a child, suspecting a deficiency in growth hormone and its early detection is essential for timely medical intervention. Parents should watch out for early signs to provide their children and consult a pediatric endocrinologist at the earliest in case of any doubt.
Understanding Growth Hormone and its Deficiency
In growth hormone deficiency the pituitary gland does not produce enough growth hormone. This condition, also known as pituitary dwarfism, causes children to have a shorter stature while maintaining normal body proportions. However, growth hormone deficiency can affect adults too.
Apart from just height, growth hormone also influences the strength of muscles and bones and the distribution of body fat. Thus, growth hormone is needed by the body even after the fusion of growth plates of the bone. Once the child has finished growing growth hormone helps in regulating the metabolism and keeps the blood sugar levels at a healthy range.
What causes Growth Hormone Deficiency?
GHD can be due to :
Congenital- Such a deficiency is present at birth and could be due to genetic mutation or structural anomalies in the brain. Several genetic mutations have been identified and include, isolated growth hormone deficiency type IA, IB, type II, and type III.
Acquired- If the pituitary gland is damaged later in life, then it could result in an acquired deficiency in growth hormone. It can develop in children and adults and the reasons can be trauma to the head, infections, tumors, or radiation therapy.
Idiopathic- This is when the cause of growth hormone deficiency is not known.
Growth hormone deficiency can occur in isolation or as part of a broader hormonal disorder and results in inadequate growth, delayed puberty, and other metabolic complications. When in combination with other disorders it presents with a much wider range of symptoms or could be diagnosed due to some other problem.
What are the Early Signs of Growth Hormone Deficiency?
Detecting the deficiency of growth hormone early is crucial for effective management. Parents should look out for the following signs and report the same to a pediatrician or a pediatric endocrinologist at the earliest.
Slow Growth Rate: A child with growth hormone deficiency typically grows less than 4 cm per year after infancy, whereas normal children grow 5-6 cm annually in pre-pubertal phase and 7-10 cm in pubertal phase.
Short Stature: Children with this deficiency are significantly shorter than their peers, with height percentiles much lower than expected for their age.
Delayed Bone Age: X-rays of the wrist often show delayed bone development compared to chronological age. These can be prescribed by the healthcare provider when the symptoms suggest growth hormone deficiency.
A younger-looking face: Children who look younger than they should at a particular age can indicate growth hormone deficiency.
Chubby Body Appearance: Despite being short, children with a deficiency of growth hormone may have an increased fat mass, particularly around the abdomen.
Late or Absent Puberty: For older children delayed onset of puberty or lack of secondary sexual characteristics should alert a parent and caregiver for an underlying problem.
Fatigue and Low Energy Levels: Children with less growth hormone may appear less active and get tired easily. However, this could also be a symptom of many other underlying health conditions.
Low Blood Sugar Levels: In infants, GHD can cause hypoglycemia (low blood sugar levels).
Delayed Teething: The eruption of primary and permanent teeth may be slower than normal.
Small Hands and Feet: Proportions remain normal, but the hands and feet of these children may appear smaller relative to age.
Impaired hair and nail growth: Fragile and less nails and hair when present with other symptoms can be a symptom of growth hormone deficiency.
Micropenis: Male newborns with growth hormone deficiency can present with a smaller penis.
Psychosocial Issues: Children with a deficiency of growth hormone may face self-esteem issues, anxiety, or social withdrawal due to their shorter stature.
Impact of GHD on Indian Children
In India, GHD is often underdiagnosed due to a lack of awareness and accessibility to pediatric endocrinology services, especially in rural areas. Moreso, societal pressures, hindrances in parents’ attitudes, and personal misbeliefs may further delay consultation for growth hormone deficiency. The impact of GHD on Indian children extends beyond height and physical development and thus requires necessary awareness.
Psychological and Social Impact
Children with growth hormone deficiency may suffer from low self-esteem and bullying due to their short stature. In Indian society, where height is often associated with social perception, these children may struggle with peer interactions and confidence.
Academic and Cognitive Effects
While GHD primarily affects growth, severe cases may impact cognitive function, leading to difficulties in concentration, memory, and academic performance.
Delayed Puberty and Emotional Challenges
Puberty is a crucial phase of development, and delayed puberty can cause emotional distress. In boys, a lack of testosterone development can result in weak muscle growth and delayed deepening of the voice, while in girls, delayed breast development and menstruation can occur.
Parental Anxiety and Social Pressure
Parents in India often worry about their children’s height and overall development due to high societal expectations and lack of awareness. This concern can lead them to seek alternative treatments, including herbal supplements or unverified therapies, instead of medical intervention.
Parents should remember that growth is highly individual and should stay away from any comparisons when it comes to their child’s development. Talking to a healthcare professional should be the first step to gaining knowledge and providing better care for their children. In the time of social media, it’s advisable to stay away from misinformation or false medical claims.
Diagnosis of Growth Hormone Deficiency
Timely diagnosis is crucial to ensure effective treatment. The diagnostic process includes:
Growth Monitoring: Regular height and weight measurements are plotted on a growth chart. Parents should ensure to follow up with their pediatrician regularly to ensure their child is growing well.
Bone Age Assessment: X-ray of the hand and wrist to determine bone development, may be suggested if needed.
Blood Tests: Measuring levels of insulin-like growth factor-1 (IGF-1) and growth hormone stimulation tests can help identify the specific cause of growth hormone deficiency.
MRI Scans: To examine pituitary gland abnormalities are used by pediatric endocrinologists if clinical growth hormone deficiency is identified.
Can Growth Hormone Deficiency Be Treated?
Yes, the effects of growth hormone deficiency can be treated, thus, identification of this condition and treatment at the right time is crucial.
The primary treatment for growth hormone deficiency is recombinant human growth hormone (rhGH) therapy. Key aspects of this therapy include-
Daily or Weekly Growth Hormone Injections: In case a growth hormone deficiency is diagnosed synthetic growth hormone is prescribed by the pediatric endocrinologist. This is administered subcutaneously at home almost daily. The injection is given preferably at night to mimic natural hormone secretion. Recently, once in a week injections also have been approved for treatment.
Regular Monitoring: Children undergoing treatment require frequent height assessments and IGF-1 level monitoring. Regular consultations even after prescribed therapy are essential to know whether the treatment is working for a particular child or not.
Nutritional Support: A balanced diet rich in proteins, vitamins, and minerals enhances growth. A diet chart for the child is made by the dietician in coordination with the pediatric endocrinologist. This ensures that the child’s individual nutritional requirements are fulfilled.
Physical Activity: Regular exercise, including stretching and strength training, supports overall development. When followed along with growth hormone therapy it can enhance the overall growth and health of the child.
Psychological Support: Counseling and support groups help children cope with self-esteem issues and social pressures. Parents and children should connect to larger groups of people with similar problems to know they are not alone.
What is the Prognosis of children who receive Treatment?
The earlier the condition is identified and treated, the better the chance that a child will grow to near-normal adult height. As one knows that there is a certain age for maximum growth, thus, one should catch this disease young to ensure the best results of treatment. In general, most children gain four or more inches of height during the first year of treatment and three or more inches during the next two years. The rate of growth then slowly decreases.
Challenges in Treating GHD in India
India comes with its own set of problems when it comes to growth hormone deficiency.
Limited Awareness: Many cases go undiagnosed due to a lack of awareness among parents and primary care physicians. Discussion and awareness around this important topic can help in combating this challenge.
Social Myths and Alternative Therapies: Many parents opt for traditional remedies instead of medical treatments due to misinformation. Parents should thus ensure to talk to a medical expert only for this condition. A pediatric endocrinologist is the right expert to treat this condition.
Growth Hormone Deficiency is a treatable condition, but early diagnosis and intervention are key to ensuring optimal outcomes. In India, raising awareness among parents, pediatricians, and healthcare workers can help bridge the gap in diagnosis and treatment. Addressing affordability and accessibility issues, along with promoting scientific approaches over myths, will ensure that children with children with growth hormone deficiency receive the care they need for a healthy and fulfilling life. With proper medical intervention, children with a deficiency of growth hormone can achieve normal height and good health, thereby leading confident, active lives.
References
https://my.clevelandclinic.org/health/diseases/23343-growth-hormone-deficiency-ghd
FAQs for Understanding Growth Hormone Deficiency in Children: Signs, Causes, Symptoms and Treatment Options
Growth Hormone Deficiency (GHD) is a medical condition in which the pituitary gland fails to produce enough growth hormone, leading to restricted physical growth and other health complications.
Early signs include slow growth rate (less than 4 cm per year after infancy), short stature compared to peers, delayed bone age, late or absent puberty, chubby body appearance, and delayed teething
GHD can be congenital (present at birth due to genetic mutations or brain anomalies), acquired (caused by head trauma, infections, tumors, or radiation), or idiopathic (with no clear cause).
Diagnosis involves tracking growth patterns, and bone age assessment through X-rays, blood tests, and MRI scans to examine the pituitary gland.
Yes, GHD is treatable with daily recombinant human growth hormone (rhGH) injections, which help children achieve near-normal height and overall growth when started early.
The earlier the diagnosis and treatment, the better the results. Ideally, treatment should begin before puberty for maximum growth potential.
Side effects are rare but may include joint pain, swelling, insulin resistance, or mild headaches. Regular monitoring by a pediatric endocrinologist ensures safe treatment.
Delayed diagnosis due to lack of awareness, societal misconceptions, limited access to pediatric endocrinologists, and financial constraints often impact treatment.
Yes, with early diagnosis and proper treatment, children with GHD can grow to a normal height, maintain good health, and lead a confident, active life.
Parents should ensure timely medical consultation, provide a nutritious diet, encourage physical activity, offer emotional support, and avoid misinformation from non-medical sources.
Author: Dr. Mounica Reddy Mandadi
Consultant Pediatric Endocrinologist and Diabetologist