Growth hormone deficiency (children) - human growth hormone

Summary

NICE has made the following recommendations about the use of human growth hormone (somatropin) to treat children with growth hormone deficiency, Turner syndrome, chronic renal insufficiency or Prader-Willi syndrome. Note that at the time this guidance was issued, somatropin was not licensed to treat children who are not growing despite normal levels of growth hormone because of another unknown reason, and so this guidance does not deal with that use of somatropin.

• Human growth hormone (somatropin) treatment is recommended for children who have growth hormone deficiency. To help diagnose growth hormone deficiency the doctor should take measurements of height and look at the results of radiological investigations and tests to measure the amount of GH in the child’s blood.
• Growth hormone treatment is recommended for girls with Turner syndrome. For the treatment to work as well as possible, they should be diagnosed and start treatment at the earliest age possible and they should be given oestrogen treatment at the right time to stimulate puberty.
• Growth hormone treatment is recommended for children with chronic renal insufficiency who have not yet reached puberty. Before giving growth hormone treatment the doctor should make sure that the child’s nutrition (food intake) and metabolism (chemical processes inside the body) are as good as possible. Treatment with steroids should be at the lowest level possible.
• Growth hormone treatment is recommended for treating children with Prader-Willi syndrome.
• A paediatrician (a doctor who specialises in treating children) who is an expert in treating children with a growth hormone disorder should always be responsible for starting and checking the progress of growth hormone treatment.
• Usually, growth hormone treatment should be stopped after the first year if the extra height gain is not at least half the height gain in the year before treatment began. For a child who continues treatment after the first year, treatment should be stopped, after discussion with the child and carer, when the expected final height has nearly been reached, or when the child has grown less than 2 cm in 1 year. Alternatively, treatment should be continued until the person can be seen by a doctor who specialises in treating adults with a hormone disorder (an adult endocrinologist).
• The doctor who is treating a child with Prader-Willi syndrome should consider the amount of fat in the body as well as height when considering when to stop treatment with growth hormone. This is because children with Prader-Willi syndrome often have too much body fat.
• The doctor should consider stopping treatment with growth hormone before a child has reached final height if the child is not taking the treatment regularly.
• If a child with chronic renal insufficiency has a kidney transplant, growth hormone treatment should be stopped. It should not usually be started again until at least 1 year after the transplant. This is so that doctors can see whether the child’s growth catches up after the transplant.

Documents

For healthcare professionals

• TA42 Growth hormone deficiency (children) - human growth hormone: Summary
• TA42 Growth hormone deficiency (children) - human growth hormone: Guidance

For patients, carers and the public

• TA42 Growth hormone deficiency (children) - human growth hormone: Information for patients
• Patient's leaflet on the use of human growth hormone (somatropin) in children with growth failure (old version)

Background information

• Review decision
• Review proposal
• Assessment report on clinical and cost effectiveness of growth hormone in children
• 2002/028 NICE launches guidance on Human Growth Hormone for Children

Implementing this guidance

Any further information NICE has produced to help the NHS implement this guideline locally is linked to below:

• None found