<unk>  is treated by replacing GH with daily injections under the skin or into muscle. Until 1985,<unk><unk>  for treatment was obtained by extraction from human pituitary glands collected at autopsy. Since 1985, recombinant human<unk><unk>  (rHGH) is a recombinant form of human GH produced by genetically engineered bacteria, manufactured by recombinant DNA technology. In both children and adults, costs of treatment in terms of money, effort, and the impact on day-to-day life, are substantial. Child GH treatment is not recommended for children who are not growing despite having normal levels of<unk><unk> , and in the UK it is not licensed for this use. Children requiring treatment usually receive daily injections of<unk><unk> . Most pediatric endocrinologists monitor<unk>  and adjust dose every 3–6 months and many of these visits involve blood tests and x-rays. Treatment is usually extended as long as the child is growing, and lifelong continuation may be recommended for those most severely deficient. Nearly painless insulin syringes, pen injectors, or a needle-free delivery system reduce the discomfort. Injection sites include the biceps, thigh, buttocks, and stomach. Injection sites should be rotated daily to avoid lipoatrophy. Treatment is expensive, costing as much as US$10,000 to $40,000 a year in the US. Adults GH supplementation is not recommended medically for the physiologic age-related decline in GH/IGF secretion. It may be appropriate in diagnosed adult-onset deficiency, where a weekly dose of approximately 25% of that given to children is given. Lower doses again are called for in the elderly to reduce the incidence of side effects and maintain age-dependent normal levels of IGF-1. In many countries, including the UK, the majority view among endocrinologists is that the failure of treatment to provide any demonstrable, measurable benefits in terms of outcomes means treatment is not recommended for all adults with severe<unk> , and national guidelines in the UK as set out by NICE suggest three criteria which all need to be met for treatment to be indicated: # Severe<unk> , defined as a peak GH response of <9mU/litre during an insulin tolerance test # Perceived impairment of quality of life, as assessed by questionnaire # They are already treated for other pituitary<unk>  disorders Where treatment is indicated, duration is dependent upon indication. Cost of adult treatment in the UK is 3000-4000 GBP annually. Side effects * Headaches * Joint pain and muscle pain * Fluid retention, and carpal tunnel syndrome * Mild hypertension * Visual problems * Nausea and vomiting * Paraesthesiae * Antibody formation * Reactions at the injection site * Rarely, benign intracranial hypertension.
Growth hormone deficiency
Prader–Willi syndrome
Isolated growth hormone deficiency
Turner syndrome
Thyroid dysgenesis
Noonan syndrome
Congenital hypothyroidism
Small for gestational age