Approach to the patient: Safety of Growth Hormone Replacement in Children and Adolescents.
Vaneeta BambaRoopa Kanakatti ShankarPublished in: The Journal of clinical endocrinology and metabolism (2021)
The use of recombinant human growth hormone (rhGH) in children and adolescents has expanded since its initial approval to treat patients with severe GH deficiency (GHD) in 1985. rhGH is now approved to treat several conditions associated with poor growth and short stature. Recent studies have raised concerns that treatment during childhood may impact morbidity and mortality in adulthood, with specific controversies over cancer risk and cerebrovascular events. We will review three common referrals to a pediatric endocrinology clinic, followed by a summary of short and long term effects of rhGH beyond height outcomes. Methods to mitigate risk will be reviewed. Finally, this information will be applied to each clinical case, highlighting differences in counseling and clinical outcomes. rhGH therapy has been used for over three decades. Data are largely reassuring, yet we still have much to learn about pharmaceutical approaches to growth in children and the lifelong impact of treatment.
Keyphrases
- growth hormone
- recombinant human
- patient safety
- quality improvement
- primary care
- replacement therapy
- early onset
- young adults
- type diabetes
- metabolic syndrome
- skeletal muscle
- big data
- bone marrow
- early life
- machine learning
- physical activity
- hepatitis c virus
- human immunodeficiency virus
- artificial intelligence
- hiv infected
- antiretroviral therapy