GH Deficiency in Children Patient Care and Monitoring

1. Assess child's growth characteristics, and compare physical height with a population standard (e.g., Centers for Disease Control and Prevention Growth Charts).

2. Obtain a thorough history and physical examination that may indicate the possible presence of GH deficiency. Exclude other identifiable causes of growth failure, such as hypothyroidism, chronic illness, malnutrition, genetic syndromes, and skeletal disorders.

3. Perform imaging tests of the hypothalamic-pituitary region to detect structural or developmental anomalies. Perform x-ray of the wrist and hand to estimate bone age.

4. Perform a provocative test to measure GH and IGF-I levels.

5. Initiate GH replacement therapy based on patient preference. Make sure that the child does not have any contraindications to GH therapy.

6. Develop a formal plan to assess response (increase in height and change in height velocity) and adverse effects of GH replacement therapy. Make dosage adjustments when appropriate.

7. May continue GH replacement therapy until child reaches satisfactory adult height, achieves documented epiphyseal closure, or fails to respond to treatment.

8. Review and retest the child using adult GH deficiency diagnostic criteria once the child reaches final adult height.

9. Provide patient education in regard to disease state and drug therapy. Discuss with the child and parents:

• GH deficiency

• Potential effectiveness and disadvantages of existing GH replacement therapy

• Importance of adherence to therapy

• Potential for adverse effects or need for lifelong replacement

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