美国Nebraska大学医学中心药学院Mary L Windle教授关于治疗生长激素缺乏症药物的详细介绍
Understanding Growth Hormone Deficiency Medications

提纲：

• What Is Growth Hormone Deficiency?
• What Causes Growth Hormone Deficiency?
• What Are the Risks of Growth Hormone Deficiency?
• Medical Treatment for Growth Hormone Deficiency
• Recombinant Human Growth Hormone
• Growth Hormone–Releasing Hormone
• For More Information
• Web Links
• Synonyms and Keywords
• Authors and Editors

What Is Growth Hormone Deficiency?

Growth hormone deficiency results from a disruption in the release of growth hormone (GH) from the pituitary gland (a gland at the base of the brain) or a disruption in other hormones from the hypothalamus (a part of the brain) that signal GH release.

What Causes Growth Hormone Deficiency?

Growth hormone deficiency may be congenital (an individual is born with the deficiency), or it may be acquired later in life. Congenital growth hormone deficiency may be caused by an abnormal pituitary gland, or it may be associated with other congenital syndromes. Acquired growth hormone deficiency may result from trauma, infections, pituitary and related tumors, radiation to the brain, brain cancer, or other diseases.

What Are the Risks of Growth Hormone Deficiency?

About 5% of children with growth hormone deficiency also have episodes in which blood sugar levels are low, especially during infancy. The low blood sugar levels resolve (get better) once growth hormone therapy is started. Other pituitary hormones may also be affected, and conditions resulting from other pituitary hormone deficiencies can even cause death. Adults with untreated growth hormone deficiency have problems such as too much body fat and not enough lean body mass, decreased bone mineralization (the process by which minerals are absorbed into bones), and increased heart disease risks (particularly because of increased cholesterol and triglyceride levels).

Medical Treatment for Growth Hormone Deficiency

Depending on the specific deficiency, growth hormone (GH) or growth hormone–releasing hormone (GHRH) may be prescribed by a doctor specializing in growth hormone deficiency (an endocrinologist). If other pituitary deficiencies are present, they may need to be treated first in order for GH replacement therapy to be effective.

Recombinant Human Growth Hormone 基因重组人类生长激素

• Generic/trade names: Somatropin (Genotropin, Humatrope, Nutropin, Saizen), somatrem (Humatrope, Protropin)
• How recombinant human growth hormone (rhGH) works: Purified growth hormone (GH) is manufactured by recombinant DNA technology. RhGH increases the growth rate in children whose long-bone growth is not yet completed.
• Who should not use these medications
  • People with allergy to rhGH
  • People with respiratory failure
  • People with active cancer
  • People with closed epiphyses (that is, with completed long-bone growth): Some evidence suggests that adults with closed epiphyses and growth hormone deficiency may still benefit from GH replacement; this is not yet a completely settled question
• Use: rhGH is administered by subcutaneous injections (shallow injections administered just under the skin). The dose is adjusted according to the growth response. Depending on which preparation is prescribed, the dose may be administered 5-7 times a week, every 2 weeks, or once each month.
• Drug or food interactions: High doses of corticosteroids (for example, prednisone [Deltasone, Meticorten]) inhibit the growth-promoting effects of rhGH. Dose adjustments may be needed for people taking diabetes medications.
• Side effects: At certain intervals, the doctor will monitor blood sugar levels. Antibodies to rhGH may develop and prevent some individuals from getting a better response.

Growth Hormone–Releasing Hormone

• Generic/trade names: Sermorelin (Geref)
• How GHRH works: Some cases of growth hormone deficiency in children are caused by failure of the hypothalamus (a part of the brain that secretes signals the pituitary to release hormones) to secrete growth hormone-releasing hormone (GHRH). Children with this problem may be treated with GHRH.
• Who should not use these medications
  • People with allergy to GHRH
  • People with active cancer
  • People with closed epiphyses (that is, with completed long-bone growth)
• Use: GHRH is administered by daily subcutaneous injections (shallow injections administered just under the skin). GHRH may also be administered 3 times a day as a nasal spray.
• Drug or food interactions: High doses of corticosteroids (for example, prednisone [Deltasone, Meticorten]) inhibit the growth-promoting effects of GHRH. Dose adjustments may be needed for people taking diabetes medications.
• Side effects: The doctor will monitor blood sugar levels according to a set schedule. Antibodies to GHRH may develop and prevent some individuals from getting better. GHRH may cause nausea, vomiting, or taste alterations.

For More Information

Web Links
Human Growth Foundation http://www.hgfound.org/index.htm
The MAGIC Foundation http://magicfoundation.org/www/docs/108/growth_hormone_deficiency_in_children.html

Synonyms and Keywords
understanding growth hormone deficiency medications, GH, GHD, GH deficiency, pituitary gland, hypothalamus, growth hormone–releasing hormone, GHRH, GH replacement therapy, recombinant human growth hormone, rhGH, growth hormone deficiency treatments, treatment of growth hormone deficiency

Authors and Editors
Author: Mary L Windle, Pharm D, Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Pharmacy Editor, eMedicine.com, Inc.

Editors: Arthur B Chausmer, MD, PhD, FACP, FACE, FACN, CNS, Affiliate Research Professor, Bioinformatics and Computational Biology Program, School of Computational Sciences; Principal, C/A Informatics, LLC; Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine; George T Griffing, MD, Director, Division of General Internal Medicine, Professor, Department of Internal Medicine, St Louis University.

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