Recombinant (man-made) Growth Hormone (HGH) is developed by using advanced DNA recombination technology to make it virtually identical to the HGH produced by the body. HGH therapy was originally given to patients with an HGH deficiency. It has only been about the last 15 years that it has been used for patients with Turner Syndrome who are not HGH deficient. There is a great deal of information still to be gathered by studies and laboratory research which are still ongoing.
The decision for a female with Turner Syndrome and her family to begin HGH therapy is a difficult one and is optional. Usually the girls are between 7-9 years of age when this decision is required for optimum results to be achieved. This can put a very heavy burden on parents and families who are required to make the final decision for the patient. It can be even more discouraging as there is not yet enough information or results from research currently being done on the effects, especially possible long term effects, HGH may have on Turner Syndrome patients. There is also still some uncertainty about the overall response that HGH will have on the patient or if it will drastically effect height. In the end, the decision to start therapy is made by the doctor, patient and family.
If a decision is made to start HGH therapy the start of estrogen therapy may be delayed to allow more opportunity for growth from the HGH therapy. Estrogen therapy is required because of other medical conditions that are prevalent in Turner Syndrome females. A girl just beginning HGH therapy may also be asked to participate in different studies throughout the years that she is on HGH therapy. The information given to the study will keep the patient’s name and identity unknown to keep confidentiality. Once on HGH therapy, females must take injections 6 days a week until their bone age is about 14 years when female bone growth matures. Patients must rotate their injection sites between their arms, thighs and even their abdomen if they desire to prevent bruising and other complications in injection sites. The dosage of HGH a female receives is determines by their weight and therefore increases as the patient grows.
There are many side effects to HGH therapy. One side effect is intercranial hypertension. This is a build up of fluid in the brain and can be detected by an eye exam. Some symptoms of intercranial hypertension are nausea, vomiting, headaches and visual changes. Though some people with intercranial hypertension experienced visual changes no one has yet gone blind from this. If left undetected and untreated death could potentially occur. This symptom usually develops shortly after beginning HGH therapy. When this occurs, the therapy is stopped which stops the fluid build-up and can be started again with no reoccurrence. A condition known as slipped femoral emphasis, which is a dislocated hip, may occur. This happens due to the increase in the speed of growth and may require surgery to resolve. Other side effects can include: increased muscle mass, increased weight, diabetes, bone deformities, drug interactions, allergic reactions and infection of injection sites. Papilledema and Scoliosis may also occur. All of these symptoms can be very discouraging to patients and taking injections can also be bothersome for some. If there are any side effects the therapy will be stopped immediately.
In order to monitor possible side effects, patients on HGH injections will have to visit their doctor every 3 months for a thorough medical examination. At each visit the patient will have their height and weight taken and plotted on a chart. Blood and urine tests will also be done. A patient will have 20-35 ml of blood taken every 3 months (110-15ml a year) and an added 10 ml will be taken for blood sugar tests. These blood tests monitor blood sugar and thyroid problems that may occur from HGH therapy. Testing for Diabetes is done if the results of the blood sugar test are elavated above normal levels where the patient has a blood test after a meal and sugar. An x-ray of the hands and wrists will also be done annually to determine the girl’s bone age. The bone age will help doctors estimate how much more growth can be achieved using the synthetic HGH.
As you can see there are many potential risks to HGH therapy and some uncertainty about its use for females with Turner Syndrome. Some people will not want to accept the risks, may not want to take injections or go to the doctor as often as necessary when on HGH therapy. Parents are especially apprehensive to put their young daughter through the therapy for these reasons. This is why it is important and preferable to find a more natural, easier way to speed growth and increase ultimate height.
Works Cited:
Informed Consent Form for the Use of Commercial Recombination Growth Hormone in Turner Syndrome. IWK Hospital, Halifax, 1997.