Growth Hormone Therapy in Pediatric Patients

Common Side Effects

The American Academy of Pediatrics recommends monitoring for intracranial hypertension, a rare but documented side effect, with baseline fundoscopy before starting GH therapy and immediate evaluation if persistent headache or vomiting occurs 1, 3
Lipoatrophy at injection sites can be prevented by rotating injection sites daily, as recommended by the Endocrine Society 3, 4
Glucose metabolism alterations, including increased insulin secretion and hyperinsulinemia, may occur during GH therapy, and close monitoring is advised, especially in patients with obesity or risk factors, according to the American Diabetes Association 1, 3, 5
Secondary hyperparathyroidism may be unmasked by increased longitudinal bone growth, and pre-existing renal osteodystrophy should be monitored, as suggested by the National Kidney Foundation 3, 4, 5, 6

Regular clinic visits every 3-6 months are recommended to monitor growth parameters, pubertal development, skeletal maturation, renal function, thyroid hormone levels, serum glucose, calcium, phosphate, bicarbonate, and parathyroid hormone levels, as advised by the American Academy of Pediatrics 2, 3, 4, 7
The Endocrine Society recommends monitoring for signs of intracranial hypertension, such as persistent headache or vomiting, and immediate evaluation including fundoscopy should be performed if these symptoms occur 1, 3

Absolute contraindications for GH therapy include known hypersensitivity to GH or its constituents, active malignancy, uncontrolled diabetes mellitus, and pre-existing papilledema, as stated by the American College of Clinical Endocrinologists 7, 8
Special populations requiring careful monitoring include patients with obesity, nephropathic cystinosis, and severe secondary hyperparathyroidism, according to the National Institute of Diabetes and Digestive and Kidney Diseases 3, 4, 5, 9

GH treatment should be discontinued when epiphyseal closure is demonstrated, at the time of renal transplantation, or in patients with persistent severe secondary hyperparathyroidism, as recommended by the American Society of Pediatric Nephrology 1, 4

Long-term registry data supports the overall safety profile of GH therapy, with similar adverse effects between GH-treated patients and control populations, according to the Food and Drug Administration 1, 2, 9
Both reference GH products and biosimilars appear to have comparable safety profiles based on pharmacovigilance data, as reported by the European Medicines Agency 3, 5

The recommended dosage of GH therapy is 0.045-0.05 mg/kg body weight per day, administered via daily subcutaneous injections in the evening, as suggested by the Endocrine Society 3, 9
Injection technique should involve changing the injection site daily to avoid lipoatrophy, and children from 8-10 years of age can be encouraged to self-administer with proper training and adherence monitoring, according to the American Academy of Pediatrics 3, 4