From the Guidelines
Growth hormone therapy is indicated for children with chronic kidney disease (CKD) who have persistent growth failure, defined as a height below the third percentile for age and sex and a height velocity below the twenty-fifth percentile, as well as for children with CKD who have received a kidney transplant and have not achieved spontaneous catch-up growth. The indications for growth hormone therapy can be broken down into several key areas, including:
- Children with CKD who have growth failure, as defined above, and who have growth potential 1
- Children who have received a kidney transplant and have not achieved spontaneous catch-up growth, with GH therapy initiated 1 year after transplantation if steroid-free immunosuppression is not a feasible option 1
- Children with CKD due to nephropathic cystinosis who have persistent growth failure, with GH therapy considered at all stages of CKD 1
- Other conditions, such as growth hormone deficiency (GHD), Turner syndrome, Prader-Willi syndrome, and Noonan syndrome, may also be indications for GH therapy, although the provided evidence does not specifically address these conditions 1
The recommended dosing for GH therapy is 0.045-0.05 mg/kg per day by daily subcutaneous injections, with the injection site changed daily to avoid lipoatrophy and evening injections recommended to mimic the physiological circadian rhythm of endogenous GH secretion 1. It is essential to discuss the pros and cons of GH treatment with individual patients and their families before initiating therapy, particularly for immobilized patients and those with syndromic kidney diseases 1. Contraindications for GH therapy include closed epiphyses, known hypersensitivity to the active substance or excipients, unwillingness of the patient or their family, severe secondary hyperparathyroidism, proliferative or severe non-proliferative diabetic retinopathy, and active malignancy 1.
From the Research
Indications for Growth Hormone (GH) Therapy
The indications for GH therapy are varied and include:
- GH deficiency 2, 3, 4
- Turner syndrome 2, 5, 3, 6
- Chronic renal insufficiency (CRI) 2, 5, 3
- Idiopathic short stature (ISS) 2, 3
- Intrauterine growth retardation (IUGR) or small for gestational age (SGA) without catch-up growth 2, 3, 6
- Prader-Willi Syndrome 3
- SHOX gene haploinsufficiency 3
- Noonan Syndrome 3, 6
- Short bowel syndrome 5
- Cystic fibrosis 5
FDA-Approved Indications
In the United States, there are 8 FDA-approved indications for pediatric GH therapy:
- GH deficiency
- Prader-Willi Syndrome
- Small for gestational age (SGA) without catch-up growth
- Idiopathic short stature
- Turner syndrome
- SHOX gene haploinsufficiency
- Noonan Syndrome
- Chronic renal insufficiency 3
Safety and Efficacy
The safety and efficacy of GH therapy vary depending on the condition being treated and the individual patient. Generally, GH therapy is considered safe and effective for many pediatric conditions, including GH deficiency, Turner syndrome, and chronic renal failure 2, 5, 6. However, the long-term administration of pharmacologic GH doses to short, mostly non-GH-deficient children must still be viewed with caution, as long-term complications cannot as yet be fully evaluated 2.