Hypopituitarism and Growth Hormone Deficiency

What might prompt a healthcare provider to begin a diagnostic workup for growth hormone deficiency?

The provider of a patient with short stature looks at the patient's heights and weights plotted on the growth chart over time, considers other subjective data such as the height of the parents

When is the best time to administer growth hormone?

At bedtime, to mimic the pituitary release of growth hormone

What are the clinical manifestations of growth hormone deficiency?

Slow growth, well-nourished apperance, growth into the third or fourth decade of life, diminished height

When looking at a growth chart of a child with suspected growth hormone deficiency, the most important thing to look for is:

Height velocity, defined as the change in the child's height over time

What is the treatment for growth hormone deficiency?

Daily growth hormone injections

How does growth hormone affect epiphyseal closure?

It is delayed

If growth hormone deficiency is left untreated, how is growth affected in the long term?

Growth will continue into 3rd or 4th decade, and end up shorter than peers

Define height velocity:

A child's height change over time

What kind of activity would best support the psychosocial development of a teenager with growth hormone deficiency?

Give the child age-appropriate activities (even if the child appears much younger), and finding activities that emphasize ability apart from physical size

What initial lab test is drawn as part of the diagnostic workup of growth hormone deficiency, and will determine whether a patient should go through growth hormone stimulation testing?

Insulin-like growth factor 1 (IGF-1)

What is the typical procedure for growth hormone stimulation testing?

Blood samples are taken every 30 minutes for a 3-hour period, during which the child receives a medication to stimulate the release of growth hormone. The child is observed for complications of those medications.

What test must be done for a definitive diagnosis of growth hormone deficiency?

What is the procedure for growth hormone stimulation testing?

How does growth hormone deficiency affect birth weight and length?

It is normal

How can growth hormone deficiency be distinguished from failure to thrive?

A child with growth hormone deficiency will have a well-nourished appearance

How does growth hormone deficiency affect birth height to weight proportion?

It is normal

Hypopituitarism is:

When the pituitary gland doesn't produce enough of one or more of the pituitary hormones

A decrease in adrenocorticotropic hormone (ACTH) directly results in a decrease of this hormone:

Cortisol

A decrease in cortisol can be dangerous because it may cause:

hypotension and hypoglycemia (remember that cortisol is your stress hormone, and when you're stressed you have high blood pressure and high blood sugar, so it makes sense that low cortisol would push your body the other direction)

Which hormones are secreted from the pituitary gland (and are relevant to this course)?

Adrenocorticotropic hormone (ACTH), the gonadotropins follicle-stimulating hormone (FSH) and luteinizing hromone (LH), growth hormone (GH), thyroid-stimulating hormone (TSH), antidiuretic hormone (ADH)

How does a deficiency of gonadotropins affect children?

Delayed or absent secondary sexual characteristics

What are the two most dangerous effects of a deficiency of adrenocorticotropic hormone?

Hypoglycemia and hypotension

What is the purpose of performing an MRI on a patient with signs of hypopituitarism?

To see if there is a lesion or tumor responsible

What is the purpose of performing a wrist X-ray on a patient with signs of hypopituitarism?

To evaluate bone age, because delayed bone maturity is a feature of hypopituitarism

How might parents inappropriately treat children with hypopituitarism?

Treating them as if they are younger than they are, because of how they appear (small and with delayed secondary sexual characteristics); they should be taught to treat the child according to chronologic age.

What are some causes of hypopituitarism?

A wide range of potential causes, including tumors, a genetic mutation, or it could be idiopathic