What is Growth Disorders ?

One of the remarkable roles of the endocrine system is the regulation of growth and development throughout our bodies. This work is directed by the pituitary gland — perhaps the most important “master gland” of the endocrine system – the ‘conductor of the endocrine orchestra’. A small oval-shaped organ at the base of the brain, the pituitary gland releases many types of hormones into the blood stream. One of these is growth hormone (GH). Once in the blood, GH travels to bone, muscle, and other tissues where it has many effects. The hypothalamus, a small structure located at the base of the brain just above the pituitary, controls the release of growth hormone by the pituitary gland. The principal stimulator of growth hormone secretion is called growth hormone-releasing hormone.

In children, for example, GH stimulates linear growth, or height. It is also important for the development of muscle and bone, and the distribution of body fat throughout the body. In adults, GH affects energy, muscle strength, bone health, and psychological well being. Having either too much or too little GH can cause health problems.

In some cases, individuals may have too much GH, a condition called acromegaly in adults. Acromegaly is usually caused by a non-cancerous tumour of the pituitary gland. In the rare instances when it occurs, too much GH in children causes gigantism. A more common growth disorder is growth hormone deficiency (GHD). This is the condition of having too little GH. There are several possible explanations for its occurrence.

• A child can be born with GHD
• The condition also may arise because of damage to the hypothalamus or pituitary gland as a child or adult because of a tumour, trauma, an infection, or radiation to the brain — usually for the treatment of a tumour
• A deficiency in GH may also have an undefined cause. (In this case, it is said to be of idiopathic origin)

Pituitary disorders, such as GH excess or GHD, are evaluated and treated by endocrinologists. Because the diagnosis and treatment of such disorders require special expertise, GPs and other medical practitioners who suspect patients have GH abnormalities should refer them to an endocrinologist.

Signs and Symptoms

Growth Hormone Excess: Signs and Symptoms

Adults with acromegaly will usually have large hands and feet, thick lips, coarse facial features, a protruding forehead and jaw, and widely spaced teeth. Often patients perspire excessively. Many of the signs and symptoms evolve slowly, so the diagnosis is often made years after the symptoms begin.

There are numerous symptoms that may be associated with acromegaly :-

• Headaches
• Numbness or burning of the hands or feet; carpal tunnel syndrome
• Glucose intolerance, or type 2 diabetes
• Cardiac dysfunction (heart failure, or enlarged heart)
• High blood pressure
• Goitre (enlarged thyroid gland)
• Sleep apnoea
• Tiredness
• Menstrual Disorders Irregular bleeding; absence of periods.
• Decreased Libido Low sex drive.
• Vision Problems Tunnel vision; vision loss.
• Psychological Problems Depression; anxiety.
• Osteoarthritis Joint pains.

In children with gigantism, the main symptom is increased linear growth (height) causing extremely tall stature.

Growth Hormone Deficiency: Signs and Symptoms

Children :-

Most children with GHD grow less than 5 cm per year, whereas children with normal GH usually grow at least 5 cm annually. Some children with congenital GHD may grow normally until age two or three, but then their growth rate slows. Others may have a slow growth starting soon after birth.

Some children with GHD have extra fat in the abdomen and face. Their blood sugar levels also may be low. They may experience emotional distress because of their appearance, which differs from that of other children their own age. As adolescents, they may be slow to show signs of sexual maturity.

A GP or paediatrician who suspects a child has GHD on the basis of a persistently below average growth rate with no other identifiable cause, should refer the patient to a paediatric endocrinologist for evaluation.

Adults :-

Adults with GHD fall into two general categories. Some individuals may have had GHD as a child and continue to have the deficiency. Other individuals may have acquired the deficiency after reaching maturity. The consequences of GHD in adults result from a lack of both GH and IGF-1.

The disorder has several possible symptoms in adults :-

• Increased body fat (particularly at the waist and in the face)
• Decreased muscle and bone mass
• Thinning skin with fine wrinkles
• Poor sweating or impaired temperature regulation
• Reduced strength and endurance
• Low energy level
• Decreased well-being (moodiness, mild depression)
• Loss of interest in sex
• Poor sleep
• Higher cholesterol levels, especially LDL (“bad”) cholesterol
• Overproduction of insulin (a hormone produced by the pancreas that regulates the levels of sugar in the blood), resulting from overweight

Growth Disorders Lifestyle and Prevention

For children

Because growth hormone is taken for years, it is good for parents of children with GHD to be aware of some safety precautions :-

• Carefully follow the directions for taking GH
• Tell all doctors who care for your child that he or she is undergoing growth hormone therapy
• Make sure your child takes any other prescription drugs exactly as prescribed
• Contact your child's doctor immediately if you have any questions about treatment or signs or symptoms which suggest a complication of GH treatment

In addition, encourage your child to have a healthy lifestyle. Eating a variety of healthy foods will help your child to grow and respond to growth hormone therapy. Be sure that your child gets regular exercise and plenty of sleep, too.

For adults :-

Adults receiving GH treatment should also eat a balanced diet, get regular exercise, and plenty of sleep.

Some adults find their lives are much better after taking GH alone. Others may find they still need some help, particularly with the psychological symptoms of GHD. You may need medication to control anxiety or lift your mood.

Counselling may be helpful too. Some forms of therapy, such as cognitive-behavior therapy, can allow you to correct negative thoughts you may be having. You also may want to join a support group with other adults who have GHD. Talking to others who have been through the same thing can be healing.