The anterior pituitary hormone that is most commonly used pharmacologically is GH. GH is responsible for linear skeletal growth, the growth of internal organs, protein synthesis, and the stimulation of many other processes that are required for normal growth. Hypopituitarism is often seen as GH deficiency before any other signs and symptoms occur. Hypopituitarism may occur as a result of developmental abnormalities or congenital defects of the pituitary, circulatory disturbances (e.g., hemorrhage, infarction), acute or chronic inflammation of the pituitary, and pituitary tumors. GH deficiency in children results in short stature (dwarfism). Adults with somatotropin deficiency syndrome (SDS) may have hypopituitarism as a result of pituitary tumors or trauma, or they may have been treated for GH deficiency as children, resulting in a shutdown of the pituitary production of somatotropin.
GH deficiency was once treated with GH injections extracted from the pituitary glands of cadavers. The supply of GH was therefore rather limited and costly. Synthetic human GH is now available from recombinant DNA (rDNA) sources, using genetic engineering. Synthetic GH is expensive, but it is thought to be safer than cadaver GH and is being used increasingly to treat GH deficiencies. Somatropin (Humatrope, Nutropin, Saizen, Genotropin, Serostim, and others) and somatropin rDNA origin (Zorbtive) are used for GH replacement today.
In the past, GH therapy was expensive and unsafe. The use of cadaver pituitaries resulted in unreliable hormone levels and, in many cases, hypersensitivity reactions to the proteins found in the drug. With the advent of genetic engineering and the development of safer, more reliable forms of GH, there has been a surge in use of the drug to treat children with short stature. Even so, the drug is still costly and not without adverse effects.
GH can be used to treat growth failure caused either by lack of GH or by renal failure. It also can help children with normal GH levels who are just genetically small. Before the drug is prescribed the child must undergo screening procedures and specific testing (including radiographs and blood tests) and must display a willingness to have regular injections. The child taking this drug will need to have pretherapy and periodic tests of thyroid function, blood glucose levels, glucose tolerance tests, and tests for GH antibodies (a risk that increases with the length of therapy). In addition, radiographs of the long bones will be taken to monitor for closure of the epiphyses, a sign that the drug must be stopped. Because the child who is taking GH may experience sudden growth, he or she will need to be monitored for nutritional needs, as well as psychological trauma that may occur with the sudden change in body image. Insulin therapy and replacement thyroid therapy may be needed, depending on the child’s response to the drug.
When receiving GH the child’s family will need instructions on storage, preparation, and administration. They also must be advised to report any lack of growth, as well as signs of glucose intolerance (thirst, hunger, voiding pattern changes) or thyroid dysfunction (fatigue, thinning hair, slow pulse, puffy skin, intolerance to the cold).
The use of GH involves an interrelationship among many subspecialists and expensive and regular medical evaluation and care. The key to the success of this therapy may be the attitude and cooperation of the young patient.
★Test ★ 1. Which of the following is a contraindication to the administration of growth hormone?
A. The height of the child is under 4 feet.
B. The child’s age is between 5 and 6.
C. The epiphyseal shaft is open.
D. The epiphyseal shaft is closed. 2. Miley has been taking growth hormones for a quite some time now. As a recipient of the agent, she should be aware that a side effect of growth hormone is:
A. Hyperthyroidism
B. Soft tissue hypertrophy
C. Dwarfism
D. Increased tumor growth
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答案 Answer 1. D. The epiphyseal shaft is closed. Rationale: A closed epiphyseal shaft is a contraindication for administration of growth hormone. There are no exact height or age requirements for the administration of growth hormone. 2. D. Increased tumor growth Rationale: Growth hormone may increase the size of a tumor if one is present. Hypothyroidism and soft tissue atrophy are the side effects. Dwarfism is the indication for therapy.
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