Growth Hormone Therapy Side Effects and Monitoring

Side Effects of Growth Hormone Therapy

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, 3
Lipoatrophy at injection sites can occur but can be prevented by rotating injection sites daily 1

Clinic visits every 3-6 months are recommended to monitor growth parameters, pubertal development, skeletal maturation, thyroid hormone levels, metabolic parameters, and parathyroid hormone levels 4, 5, 3, 2, 1
Polysomnography is recommended before and 6-10 weeks after beginning GH treatment to monitor for potential sleep apnea, particularly in at-risk populations 5

GH therapy should be discontinued when epiphyseal closure is demonstrated, at the time of renal transplantation, in patients with persistent severe secondary hyperparathyroidism, with occurrence of intracranial hypertension, in patients with slipped capital femoral epiphysis, or if the patient does not adequately respond to GH treatment despite optimal nutritional and metabolic control 2, 3, 4

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, 6
Evening injections are recommended to mimic the physiological circadian rhythm of endogenous GH secretion 2, 6
The recommended dosage of GH therapy is 0.045-0.05 mg/kg body weight per day by subcutaneous injection 2, 4
The American Academy of Pediatrics recommends evaluating behavioral changes in a child receiving GH therapy and considering other potential causes, consulting with appropriate specialists if needed 5