26.2 Growth Hormones and Suppressants

Growth hormone therapy is a game-changer for those with growth disorders. It uses recombinant human growth hormone to stimulate growth, cell reproduction, and more. This treatment can help kids reach normal height and improve adults' quality of life.

Nurses play a crucial role in managing growth hormone therapy. They monitor patients' growth, administer injections, and watch for side effects. Patient education is key, covering proper injection techniques, lifestyle tips, and the importance of sticking to the treatment plan.

Growth Hormone Therapy

Key characteristics and actions of growth hormone drugs

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• Recombinant human growth hormone (rhGH) treats growth hormone deficiency and other disorders binds to growth hormone receptors stimulating growth, cell reproduction, protein synthesis, lipolysis, and glucose production
• Somatropin most commonly prescribed form of rhGH administered via subcutaneous injection with dosage individualized based on patient response and IGF-1 levels
• Growth hormone therapy normalizes height and achieves normal adult stature in children with growth disorders (Turner syndrome, Prader-Willi syndrome, Noonan syndrome, idiopathic short stature)
• In adults, growth hormone therapy treats adult-onset growth hormone deficiency improving body composition, bone density, cardiovascular risk factors, and quality of life

Indications, side effects, and contraindications

• Indications: pediatric growth hormone deficiency, Turner syndrome, Prader-Willi syndrome, Noonan syndrome, idiopathic short stature, adult-onset growth hormone deficiency
• Common side effects: headache, muscle pain, joint pain, edema, carpal tunnel syndrome, insulin resistance
• Rare but serious side effects: benign intracranial hypertension (pseudotumor cerebri), slipped capital femoral epiphysis, scoliosis progression
• Contraindications: active malignancy, acute critical illness, severe obesity, severe respiratory impairment, active proliferative or severe non-proliferative diabetic retinopathy, hypersensitivity to the drug or its components

Nursing considerations

• Assess patient's growth and development (height, weight, body proportions)
• Monitor IGF-1 levels adjusting dosage to maintain levels within normal range for age and sex
• Administer growth hormone via subcutaneous injection rotating injection sites to prevent lipoatrophy
• Educate patients and caregivers on proper injection technique and medication storage
• Monitor for side effects (headache, edema, joint pain) and signs of benign intracranial hypertension (headache, vision changes, nausea)
• Monitor blood glucose levels assessing for insulin resistance
• Collaborate with multidisciplinary team (endocrinologists) to ensure optimal patient care

Patient education points

• Emphasize adherence to prescribed dosage and administration schedule
• Teach proper injection technique and site rotation using a new needle for each injection and allowing refrigerated medication to reach room temperature before injecting
• Instruct patients to report side effects to healthcare provider
• Encourage regular follow-up visits to monitor growth, development, and treatment response
• Discuss maintaining a healthy lifestyle (balanced diet, regular exercise)
• Inform patients that growth hormone therapy is a long-term commitment and results may not be immediately apparent
• Advise patients to inform all healthcare providers about their growth hormone therapy as it may interact with other medications or affect surgical procedures
• Provide emotional support and resources for coping with psychological aspects of growth disorders and treatment