Growth hormone deficiency (GHD) is a condition characterized by the insufficient secretion of growth hormone from the pituitary gland, leading to short stature and other related health issues. Growth hormone treatment (GHT) is a medical intervention that can help children with GHD to achieve normal growth and development. However, the best age to start GHT remains a topic of debate among medical professionals. This paper aims to provide an in-depth analysis of the available evidence to determine the optimal age to initiate GHT.
Factors to Consider:
Age at Diagnosis: The age at diagnosis of GHD plays a crucial role in determining the best age to start GHT. Children diagnosed with GHD at a younger age may benefit from earlier treatment initiation to promote normal growth and development. Early treatment can help to ensure that children with GHD reach a normal height potential and reduce the risk of psychological issues associated with short stature. Therefore, it is essential to consider the age at diagnosis when determining the best age to start GHT.
Peak Height Velocity: Peak height velocity (PHV) is the age at which a child experiences the fastest growth rate. GHT is most effective when initiated before PHV, as it can help to maximize growth potential. Initiating GHT before PHV ensures that children with GHD can take full advantage of their growth potential during the critical period of PHV. Therefore, determining the PHV and initiating GHT before this period can help to promote optimal growth and development in children with GHD.
Bone Age: Bone age is an X-ray evaluation of the skeleton that can help to determine the maturity of a child’s bones. GHT may be more effective when initiated before the bones mature, as it can help to promote normal bone growth. Initiating GHT before bone maturity can help to ensure that children with GHD reach a normal height potential and reduce the risk of skeletal issues associated with growth hormone deficiency. Therefore, evaluating bone age is an essential factor to consider when determining the best age to start GHT.
Psychological Factors: The psychological impact of short stature should also be considered when determining the best age to start GHT. Initiating treatment earlier may help to reduce the psychological effects of short stature and improve a child’s self-esteem. Children with GHD may experience psychological issues such as low self-esteem, anxiety, and depression due to their short stature. Early treatment can help to alleviate these psychological issues and improve the quality of life for children with GHD. Therefore, psychological factors should be considered when determining the best age to start GHT.
Evidence-Based Recommendations:
AACE Recommendations:
The AACE recommends initiating GHT in children with GHD as soon as the diagnosis is confirmed, provided that the child is less than 4 years old (1). The rationale behind this recommendation is that early initiation of GHT in children with GHD has been shown to improve final adult height and overall growth outcomes. Additionally, early detection and treatment of GHD can help prevent the psychological and social consequences of short stature.
LWPES Recommendations:
The LWPES recommends initiating GHT in children with GHD before the age of 6, provided that the child is less than 2 standard deviations below the mean for height (2). The LWPES recommendation is based on a large body of evidence showing that early initiation of GHT in children with GHD leads to improved growth outcomes. The LWPES also highlights the importance of monitoring growth velocity and adjusting treatment as necessary to ensure optimal growth outcomes.
ESPE Recommendations:
The ESPE recommends initiating GHT in children with GHD before the age of 4, provided that the child is less than 2 standard deviations below the mean for height (3). The ESPE recommendation is based on a systematic review of the literature, which showed that early initiation of GHT in children with GHD leads to improved growth outcomes. The ESPE also emphasizes the importance of regular monitoring and adjustment of treatment to ensure optimal growth outcomes.
Comparison of Recommendations:
While there are some differences in the specific age ranges and height cutoffs recommended by each organization, there is a general consensus that early initiation of GHT in children with GHD leads to improved growth outcomes. All three organizations also emphasize the importance of regular monitoring and adjustment of treatment to ensure optimal growth outcomes. The AACE recommendation to initiate GHT as soon as the diagnosis is confirmed is the most aggressive, while the LWPES and ESPE recommendations are more conservative.
Conclusion:
Based on the available evidence, initiating GHT in children with GHD before the age of 4 appears to be the most beneficial approach. This allows for maximum growth potential, normal bone development, and reduced psychological effects of short stature. However, the final decision should be made on a case-by-case basis, taking into account the individual needs and circumstances of each child. Further research is needed to determine the long-term effects of GHT and to refine the recommendations for the best age to start treatment.
