Growth Hormone Therapy and Hyperactivity
Growth hormone (GH) therapy does not cause hyperactivity as a documented side effect according to current clinical guidelines and evidence.
Side Effects of Growth Hormone Therapy
GH therapy has several well-documented potential side effects that require monitoring, but hyperactivity is not among them:
- Intracranial hypertension is a rare but serious potential side effect requiring baseline fundoscopy before initiating GH therapy and immediate evaluation if persistent headache or vomiting occurs 1
- Glucose metabolism alterations, including increased insulin secretion and hyperinsulinemia, may occur during treatment, requiring close monitoring especially in patients with obesity or other risk factors 2, 1
- Secondary hyperparathyroidism may be exacerbated by GH therapy, possibly due to direct stimulatory effects on the parathyroid gland or subtle effects on calcium and phosphate homeostasis 2
- Lipoatrophy at injection sites can occur but can be prevented by rotating injection sites daily 1
Monitoring Recommendations During GH Therapy
Regular monitoring is essential to evaluate response to GH and detect potential adverse effects:
- Clinic visits every 3-6 months are recommended to monitor:
- Polysomnography (sleep study) is recommended before and 6-10 weeks after beginning GH treatment to monitor for potential sleep apnea, particularly in at-risk populations 2
GH Therapy and Attention-Deficit/Hyperactivity Disorder (ADHD)
Research specifically examining the relationship between GH therapy and ADHD has found:
- Studies comparing children receiving both GH therapy and ADHD stimulant medication with those receiving only GH therapy showed no significant difference in linear growth response when matched for baseline measurements 3
- In patients with idiopathic GH deficiency (IGHD), concurrent ADHD therapy was associated with only a slight decrease in height standard deviation score (SDS) during GH treatment, but the magnitude was small and should not deter concurrent therapy 4
- In patients with idiopathic short stature (ISS), concurrent ADHD therapy had no effect on the change in height SDS 4
When to Stop GH Treatment
GH therapy should be discontinued in the following circumstances:
- When epiphyseal closure is demonstrated 2
- At the time of renal transplantation 2
- In patients with persistent severe secondary hyperparathyroidism (PTH >500 pg/ml) 2
- With occurrence of intracranial hypertension 2
- In patients with slipped capital femoral epiphysis 2
- If the patient does not adequately respond to GH treatment despite optimal nutritional and metabolic control 2
Clinical Considerations
- Both GH reference and biosimilar products are recommended for use in children with appropriate indications, as pharmacovigilance activities have not identified any relevant differences in safety profiles 2
- Evening injections are recommended to mimic the physiological circadian rhythm of endogenous GH secretion 2
- The recommended dosage of GH therapy is 0.045-0.05 mg/kg body weight per day by subcutaneous injection 2
Important Caveats
- While GH therapy does not cause hyperactivity, it's important to note that behavioral and psychological issues may coexist in patients with GH deficiency
- Some studies have found that GH-deficient patients may experience anxiety, depression, and other psychological disorders that could impact quality of life 5
- These psychological manifestations are likely related to the underlying condition rather than the GH therapy itself 5
- When evaluating behavioral changes in a child receiving GH therapy, consider other potential causes and consult with appropriate specialists if needed