Treatment of Growth Disorders

1. Candidates for Growth Hormone Treatment

In South Korea, medical coverage is currently recognized for pediatric growth hormone deficiency, Turner syndrome, pediatric chronic renal failure, adult growth hormone deficiency, Prader-Willi syndrome, Noonan syndrome, and cases in which a child is born small for gestational age and catch-up growth does not occur. Because the detailed criteria differ for each disease, caution is required. Idiopathic short stature, including familial short stature, is also a candidate for growth hormone treatment, but medical coverage is not yet recognized in South Korea, so the treatment cost is substantial.

2. Practical Aspects of Growth Hormone Treatment

Growth hormone is administered by subcutaneous injection 5 to 7 times a week. Since growth hormone is secreted mostly during sleep at night, the injection is given every evening 30 minutes before bedtime. It is effective to inject without missing any days. Injection sites include the upper arms, outer thighs, and buttocks, where there are no vital organs and there is little risk of injuring large blood vessels or nerves. Recently, a long-acting growth hormone treatment administered once a week has been developed and is being used in Korea. While receiving growth hormone treatment, periodic blood tests and bone age examinations should be performed to check its effectiveness and side effects.

3. Side Effects of Growth Hormone Treatment

Side effects of growth hormone treatment include edema, gynecomastia in boys, diabetes, scoliosis, slipped capital femoral epiphysis, increased size of moles, increased intracranial pressure, and headache. Many studies have investigated whether growth hormone increases the risk of tumors, but there is no evidence that tumors occur more frequently in patients receiving or having received growth hormone. It also does not cause puberty to occur early, nor does it accelerate the maturation of bones or teeth. Long-term side effects or problems appearing long after growth hormone treatment has ended are also currently known to be absent. At present, about 200,000 patients worldwide have been receiving or have received growth hormone for more than 30 years, and it is considered a relatively safe medication with no serious side effects other than those mentioned above, but it should not be overused. Therefore, during growth hormone treatment, regular outpatient examinations and blood tests are recommended.

4. Treatment for Precocious Puberty

In children with precocious puberty, simply delaying puberty can help them grow taller. Precocious puberty includes central precocious puberty, which occurs when the hormone secretion axis from the hypothalamus  pituitary gland  gonads becomes active too early, and peripheral precocious puberty, which appears due to abnormalities of the ovaries or adrenal glands without stimulation by gonadotropins. If central precocious puberty is diagnosed, a gonadotropin-releasing hormone agonist is injected subcutaneously or intramuscularly once every 4 weeks to prevent pubertal progression. After treatment to delay puberty, the breasts of girls may become slightly smaller, and the testes of boys decrease in size. However, when treatment is stopped, puberty resumes after about 3 to 6 months, and bodily changes progress again. Treatment to delay puberty is best continued so that puberty occurs at the normal time alongside other children of the same age, and treatment usually lasts 2 to 3 years. While receiving treatment to delay puberty, growth rate may slow, but because growth continues for a longer period than before treatment, final height becomes greater.

5. Surgical Treatment: The Ilizarov Method

This is a surgical method of lengthening the leg bones when the growth plates have closed and height can no longer increase even with growth hormone injections. Devised in 1951 by the Soviet surgeon Ilizarov, this method was originally created to gradually lengthen short bones in cases where limbs were bent due to bone deformities or the leg lengths were different.

In this procedure, an Ilizarov external fixation device, a rod-shaped rapid-fixation apparatus, is attached to the area where the bone will be lengthened, and after about one week, it is lengthened by 1 mm per day. Usually, about 0.5 to 1 cm is lengthened per month, allowing an increase in height of about 6 cm over 6 to 12 months. According to reports, there have been cases in patients with achondroplasia where 10 to 15 cm of lengthening was achieved, but the course may vary depending on the surgeon or the patient's characteristics.

This surgical method may cause side effects such as nerve or blood vessel damage, inflammation at the surgical site, and pain. It also requires long-term hospitalization and physical therapy to prevent secondary leg deformities that may occur as the bone is lengthened. Because of these side effects, it is limited to cases in which one leg is short, bones are bent due to genetic causes, or a patient with achondroplasia has residual effects of a fracture.

So far, we have explained the treatment of growth disorders.

In the next part, we will look at vitiligo.

Source: Korea Disease Control and Prevention Agency National Health Information Portal