What is growth hormone deficiency in children?
Growth hormone deficiency is a condition where the pituitary gland produces insufficient growth hormone, leading to reduced growth velocity, short stature, delayed bone age, and increased body fat.
What are the main causes of growth hormone deficiency?
Causes include congenital defects like pituitary hypoplasia, genetic mutations, and midline defects, as well as acquired causes such as brain tumors, cranial irradiation, trauma, and infections. Many cases are idiopathic.
How is growth hormone deficiency diagnosed?
Diagnosis involves growth chart assessment, delayed bone age on X-ray, low IGF-1 levels, and confirmation with growth hormone stimulation tests such as insulin tolerance or clonidine test.
What is the treatment for growth hormone deficiency in children?
Treatment is recombinant growth hormone (somatropin) given as daily subcutaneous injections, with dose adjustment based on growth response and IGF-1 levels.
What are the complications of growth hormone therapy?
Complications include intracranial hypertension, slipped capital femoral epiphysis, edema, arthralgia, and rarely glucose intolerance.
What is congenital hypothyroidism?
Congenital hypothyroidism is a condition present at birth where the thyroid gland is absent, underdeveloped, or unable to produce adequate thyroid hormone, leading to impaired growth and brain development.
What are the symptoms of hypothyroidism in children?
Symptoms include short stature, weight gain, fatigue, constipation, cold intolerance, dry skin, delayed puberty, and poor school performance. In neonates, signs include prolonged jaundice and macroglossia.
How is pediatric hypothyroidism diagnosed?
Diagnosis is based on elevated TSH and low T4 levels in primary hypothyroidism, along with thyroid antibody testing and newborn screening programs.
What is the treatment for hypothyroidism in children?
Treatment is levothyroxine replacement therapy, given orally with dosing adjusted according to age and regular monitoring of TSH and T4 levels.
Why is early treatment of congenital hypothyroidism important?
Early treatment within the first 2 weeks of life prevents irreversible intellectual disability and ensures normal growth and neurodevelopment.
What is the difference between growth hormone deficiency and hypothyroidism in children?
Both cause short stature and delayed bone age, but hypothyroidism typically presents with weight gain and cognitive impairment, while growth hormone deficiency usually has normal intelligence and increased fat mass.
What is IGF-1 and its role in growth?
IGF-1 (insulin-like growth factor 1) is produced in the liver in response to growth hormone and mediates most of the growth-promoting effects on bones and tissues.
What is the role of newborn screening in hypothyroidism?
Newborn screening detects elevated TSH early, allowing prompt treatment before symptoms develop, preventing cretinism and developmental delay.
Can hypothyroidism affect intelligence in children?
Yes, untreated hypothyroidism, especially congenital, can lead to irreversible intellectual disability due to impaired brain development.
What are common drug interactions with levothyroxine?
Iron, calcium, soy products, and certain medications reduce levothyroxine absorption and should be taken at different times.
