What medications can increase height in children with growth hormone deficiency or other conditions?

Medications to Increase Height in Children with Growth Deficiency

Growth hormone (GH) therapy is the primary medication that can effectively increase height in children with growth hormone deficiency and other conditions causing short stature, with demonstrated improvements in final adult height when initiated early and used appropriately. 1

Growth Hormone Therapy Indications

Growth hormone therapy is indicated for the following conditions:

• Growth hormone deficiency (GHD)
• Chronic kidney disease (CKD) stages 3-5 or on dialysis
• Turner syndrome
• Small-for-gestational age with failure to catch up
• Prader-Willi syndrome
• Idiopathic short stature
• SHOX gene haploinsufficiency
• Noonan syndrome 2

Specific Criteria for GH Therapy

For children with CKD, GH therapy is recommended when:

• Height is below the third percentile AND height velocity is below the 25th percentile for at least 6 months in children (3 months in infants)
• Other treatable risk factors for growth failure have been addressed
• The child has growth potential (open epiphyses) 1

For children with height between the 3rd and 10th percentile, GH therapy may be considered if they show persistent low height velocity (below 25th percentile) despite addressing other growth factors. 1

Dosing and Administration

• Standard dosing: 0.23-0.33 mg/kg/week for GH deficiency 3
• Higher doses (0.33 mg/kg/week) may be needed for idiopathic short stature 3
• Administration is via subcutaneous injection
• Somatropin has a bioavailability of approximately 81% after subcutaneous administration 4

Mechanism of Action

Growth hormone works by:

1. Binding to dimeric growth hormone receptors on target tissue cells
2. Stimulating production of insulin-like growth factor 1 (IGF-1) in the liver and locally
3. Directly stimulating skeletal growth at epiphyseal plates
4. Increasing both number and size of skeletal muscle cells
5. Promoting protein synthesis and nitrogen retention 4

Efficacy in Different Patient Groups

Children with CKD

• Long-term studies show cumulative increase in standardized height of 1.1-1.9 SDS within 5-6 years
• Better response in children with:
  • Earlier CKD stages (compared to dialysis)
  • Higher residual renal function
  • Younger age at treatment initiation
  • Longer treatment duration 1

Infants with CKD

• GH therapy should be considered for infants >6 months with CKD stages 3-5 or on dialysis
• Helps accelerate length and weight gain
• May help achieve body size required for renal transplantation 1

Transplant Recipients

• GH therapy should be initiated 1 year after transplantation if:
  • Height remains below 3rd percentile
  • Height velocity below 25th percentile
  • Spontaneous catch-up growth has not occurred
  • Steroid-free immunosuppression is not feasible 1

Contraindications

GH therapy should NOT be started in:

• Patients with closed epiphyses (no growth potential)
• Known hypersensitivity to GH or excipients
• Patient/family unwillingness
• Severe secondary hyperparathyroidism (PTH >500 pg/ml)
• Proliferative or severe non-proliferative diabetic retinopathy
• During first year after renal transplantation
• Acute critical illness
• Active malignancy 1

Monitoring and Response Assessment

For patients not responding adequately to GH therapy:

• Assess adherence to therapy
• Measure serum IGF-1 levels
• Check weight-adjusted GH dosage
• Evaluate nutritional and metabolic factors 1

GH therapy should be discontinued when:

• Patient does not respond after 6 months of treatment
• Height velocity drops below 2 cm/year in late puberty
• Epiphyseal growth plate closure is evident
• Patient reaches genetic target height
• Severe adverse effects occur 1

Common Pitfalls and Caveats

1. Delayed initiation: Starting GH therapy at an older age reduces effectiveness; earlier treatment yields better outcomes.

2. Inadequate dosing: Doses must be adjusted based on weight as the child grows.

3. Unrealistic expectations: While GH therapy can significantly increase height, results vary between individuals and conditions.

4. Ignoring other growth factors: Nutrition, metabolic control, and other medical conditions must be optimized alongside GH therapy.

5. Inappropriate use: GH should not be used in children of normal height to increase stature, as this represents a desire rather than a medical need 5.

6. Discontinuation at transplantation: GH must be stopped at the time of renal transplantation but may be restarted one year later if growth failure persists 1.

GH therapy has transformed outcomes for children with growth disorders, with a favorable safety profile when used appropriately for indicated conditions.