growth hormone deficiency in children

Growth Hormone Use in Children (CIGNA PHARMACY COVERAGE)

For growth hormone deficiency in children (including pituitary dwarfism), when ALL of the following criteria are met:

==>; auxologic evaluation (stature and growth velocity data), including ONE of the following:

• individual’s height is more than two standards of deviation (SD) below average for the population mean height for age and sex, AND a height velocity measured over one year is more than one SD below the mean for chronological age, OR for children over two years of age, there is a decrease in height SD of more than 0.5 over one year.
•  individual’s height velocity measured over one year is more than two SD below the mean for age and sex OR more than 1.5 SD below the mean sustained over two years 

==>diagnostic evaluation, including ALL of the following:

• growth hormone response of less than 10 ng/mL to at least two provocative stimuli of growth hormone release: Insulin, Levodopa, L-Arginine, Clonidine, Glucagon. One  abnormal growth hormone stimulation test is sufficient for children with defined central  nervous system (CNS) pathology (e.g., empty sella syndrome, interruption of pituitary stalk,  hypoplasia of the pituitary gland, craniofacial developmental defects, pituitary or hypothalamic tumors, etc.);multiple pituitary hormone deficiency (MPHD) (i.e., deficiency of  two or more pituitary hormones) or a proven genetic defect affecting the growth hormone axis. 
• other pituitary hormone deficiencies, e.g., thyroid, cortisol or sex steroids, have been ruled out and/or corrected prior to time of testing 
• for children with either documented panhypopituitarism, defined by the absence of all other anterior pituitary hormones [Luteinizing Hormone(LH), Follicle Stimulating Hormone (FSH), Thyroid Stimulating Hormone (TSH), Adrenocorticotropic Hormone (ACTH)], or a history of cranial irradiation it may be assumed that growth hormone is also absent and no stimulation testing is required. 

==>Standard re-auth criteria apply:

• Yearly reassessment for re-authorization of coverage is required. 
• Coverage for continuation of therapy requires meeting current initial use criteria and evidence of a beneficial response as shown by growth curve chart 
• Coverage for growth promotion will cease when the bony epiphyses have closed.  

==>Small for Gestational Age (SGA) when ALL of the following criteria are met:

• child was born small for gestational age, defined as birth weight and/or length at least two standard deviations below the mean for gestational age 
• child fails to manifest catch-up growth by two years of age, defined as height at least two standard deviations below the mean for age and sex

 Yearly reassessment for reauthorization of coverage is required. 

Coverage for continuation of therapy requires meeting current initial diagnosis criteria only and evidence of a beneficial response as shown by growth curve chart. Coverage for growth promotion will cease when the bony epiphyses have closed.

Note: For consideration for Russell Silver Syndrome or chromosomal anomalies, please refer to end criteria section listing experimental, unproven, investigational indications.  

==>For Growth Delay in Children with Chronic Kidney Disease when ALL of the following criteria are met:

• renal function at stage 2 chronic kidney disease (or GFR from 60–89 ml/min/1.73m2)

==>auxologic evaluation (stature and growth velocity data)

Yearly reassessment for reauthorization of coverage is required. 

Coverage for continuation of therapy requires meeting current initial use criteria and evidence of a beneficial response as shown by growth curve chart. Coverage for growth promotion will cease when the bony epiphyses have closed.

 ==>For Turner Syndrome, when ALL of the following criteria are met:

• documentation of diagnosis as established by genetic testing
• auxologic evaluation (stature and growth velocity data)

 ==>For Prader-Willi Syndrome, when ALL of the following criteria are met:

• diagnosis of Prader-Willi Syndrome is confirmed by appropriate genetic testing
• auxologic evaluation (stature and growth velocity data)

     
 ==>For Noonan Syndrome, when ALL of the following criteria are met:

• diagnosis of Noonan Syndrome is confirmed by appropriate genetic testing 
• auxologic evaluation (stature and growth velocity data)       

==>For SHOX (short stature homeobox-containing gene) gene deletion treatment when ALL of the following criteria are met:

• diagnosis of SHOX gene deletion is confirmed by appropriate genetic testing 
• auxologic evaluation (stature and growth velocity data)

  
(stature and growth velocity data)
*individual’s height is more than two standards of deviation (SD) below average for the population mean height for age and sex, AND a height velocity measured over one year is more than one SD below the mean for chronological age, OR for children over two years of age, there is a decrease in height SD of more than 0.5 over one year          
*individual’s height velocity measured over one year is more than two SD below the mean for age and sex OR more than 1.5 SD below the mean sustained over two years.



Ref:
[2] CIGNA PHARMACY COVERAGE for Humatrope® Nutropin® and Nutropin AQ®

Grow Taller With HGH

 You heard what is HGH ,you also been told human growth hormone HGH can help in muscle building,what about the HGH effect on grow taller?

According to experts,it's possible but the results may very form individual,the question of whether you can grow taller with increased supply of human growth hormone is only relevant IF your growth plates are still OPENED..

You ask, what is growth plate? The growth plate, also known as the epiphyseal plate or physis, is the area of growing tissue near the end of the long bones in children and adolescents.For those who have stopped growing, the plate is replaced by an epiphyseal line.You can check out more detail definition about growth plate at Wiki.

In human body,every single long bone has at least two growth plates: one at each end. The growth plate determines the future length and shape of the mature bone.It's one of the key elements to determine how tall a person can be.



 How To We Know the growth plates Status
When growth is complete–sometime during adolescence–the growth plates close and are replaced by solid bone.Unfortunately there is no easy way find out whether a growth plate is still opened or not, the only way to know for sure is to have an x-ray done on the bones by a doctor.


For those whose growth plates are still open, an increased amount of human growth hormone can lead to height increase.

Through past research of human growth and development it has been proven that most young adults can still grow tall up to several inches.

This is due to the important role of our spinal column in relation to human growth. The length of the spinal column significantly contributes to human height – about 30% of the total height.

If your growth plates are indeed completely closed human growth hormone will likely do nothing for you as far as height increase is concerned. The good news is you can try other height increase methods.There are bunch of info on how to grow taller that you can search from internet.




Ref:
whatshghhumangrowthhormone.blogspot.com

Image illastration:
commons.wikimedia.org/wiki/File:Human_Growth.png
 
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HGH Treatment For Children

You might think most of the time HGH is for bodybuilding and aging people.How about HGH Treatment FOR Children? Did you now Children who born small for gestational age (SGA) who do not show catch-up in the first 2 years generally remain short for life.

How Human Growth Hormone work in children?The human growth hormone has two cycles which are direct cycle and indirect cycle.Before we go any detail to explain how and what hgh effect on children ,you should know What is Human Growth Hormone(hGH). The direct cycle are the result of human growth hormones binding its receptors on target cells (. During the indirect cycle, human growth hormone is primarily released in pulses that take place during the beginning phases of sleep.

Growth hormone is rapidly converted in the liver to its powerful growth promoting metabolite, Insulin like Growth Factor - Type 1 (IGF-1), also referred to as Somatomedin C . IGF-1 causes most of the effects associated with growth hormone . It is measured in the blood to determine the level of growth hormone secretion . Most of the beneficial effects of human growth hormone are directly attributable to IGF-1 .

Although the majority of children born SGA are not growth hormone (GH) deficient, GH treatment is known to improve average growth in these children. Early studies using HGH in children born SGA demonstrated increased height velocity, but these effects tended to be short-term with effects decreasing when Human growth hormone HGH treatment stopped.

With refined GH regimens, significant effects on height have been shown, with gains of approximately 1 standard deviation score after 2 years. Studies have also shown that long-term continuous GH therapy can significantly increase final height to within the normal range.

GH treatment of children born SGA does not appear to unduly affect bone age or pubertal development. Growth prediction models have been used to identify various factors involved in the response to GH therapy with ageat start, treatment duration, and GH dose showing strong effects.

Genetic factors such as the exon 3 deletion of the GH receptor may contribute to short stature of children born SGA and may also be involved in the responsiveness to GH treatment, but there remain other unknown genetic and/or environmental factors.

No unexpected safety concerns have arisen in GH therapy trials. In particular, no long-term adverse effects have been seen for glucose metabolism, and positive effects have been shown for lipid profiles and blood pressure. GH treatment in short children born SGA has shown a beneficial, growthpromoting effect in both the short-and long-term, and has become a recognized indication in both the US and Europe.

Indirect Effects are mediated primarily by Insulin like Growth Factor, a hormone that is secreted from the liver and other tissues in response to human growth hormones .A majority of the effects of human growth hormones is actually due to IGF-1 acting on target cells . The two feedback circuits, negative feedback circuit and positive feedback circuit, are the heart of the endocrine system. The negative feedback circuit uses two hypothalamic hormones, GHRH and SS, to control the secretion of growth hormone; meanwhile, positive feedback is seen when the output of a pathway stimulates inputs to the pathway.

According to the test, the only effective way to increase the secretion of growth hormone is to minimize the effect of the negative feedback circuit by creating a natural positive feedback circuit .

The side effects of HGH injections

HGH injections are good for helping children to grow. However, the side effects of HGH may include: ear infection, abdominal pain or bloating, changes in vision, headache, nausea and vomiting, skin rash or itching, carpal tunnel syndrome, enlargement of breasts, joint pain, muscle pain, fatigue and swelling of hands, feet or lower legs . If HGH is given to children with normal growth, serious side effects may occur because levels in the body become too high. They include development of diabetes; abnormal growth of bones and internal organs such as the heart, kidneys and liver; hardening of the arteries, and high blood pressure . New research also suggests a link to colorectal cancer later in life . Long-term over-dosage could result in symptoms of acromegaly, or excessive bone growth . HGH injections should not be given to children with normal growth because they could get diabetes and develop malformed growth of bones and internal organs, hardening of the arteries, and high blood pressure.

Further studies on individualized treatment regimens and long-term safety are ongoing.

Reference Resources:

• http://www.hmedicine.com/news/guide/hgh.php
• http://www.humangrowthhormone.nu/explain.html
• http://www.msnbc.com/news/785625.asp
• http://www.growtaller.net/advancedexplanations.html

Whats Side effects of HGH

 This article is a draft version.Check out complete version at Known side effects of HGH

Human Growth Hormone (HGH) is a hormone in a human body. Before we talk about Whats Side effects of HGH,we should know what is HGH.

HGH is made by the pituitary gland located deep interior the mind, just behind the eyes. It is one of the most important element to development and growth in humans body.In new born baby or young children HGH dependent on the correct secretion of HGH and once adulthood is reached,it performances an significant function in metabolism.

Image via Wikipedia

It is a well-known that HGH is to responsible for a individual growth, but there are other localities where HGH assists in human development. HGH is verified to turn around sinew trashing in individuals pain from AIDS. It is asserted (not yet proven) that HGH supplements slow down the aging and making one life live longer.

How is HGH made
HGH is today made of advent genetic technology which is a convoluted procedure. A couple of decades before HGH was made by eliminating the pituitary gland from dead bodies and processing it. The processed hormones were injected into HGH deficient persons.

What is HGH utilized for
HGH today need not be granted by your medical practitioner as an injection. They are accessible as tablets and nasal sprays.

HGH is cooperative for young children with HGH deficiency. This deficiency holds their development stunted. HGH supplements help them augment normally. This remedy will not be of any use to a stunted progeny who has got a usual secretion of HGH, but is stunted due to some other reason.

Many athletes have taken to utilising HGH for its asserted sinew construction and stamina expanding properties.

The use of HGH has expanded of late since advertisers make you accept as factual that HGH is the illusion potion that can therapy a huge kind of ailments. Many drop for these untrue and unproved assertions and take HGH without any health consultation. It is very likely that such persons will bear from some edge consequences, not benefiting at all.

Side Effects of HGH
Use of HGH under health supervision for HGH deficiency is protected and will have couple of edge effects. The risk of edge consequences boost when HGH is taken in higher doses without any health supervision.

The most widespread edge effect of the surplus use of HGH is acromegaly. This is a health status that starts with the overgrowth of facial skeletal part and connective tissue, premier to a altered look due to protruding jaw and eyebrow bones. This status furthermore directs to an abnormal development of the hands and feet with an expanded development of hair all over the body. Contrary to expanding your life, this status will reduce life expectancy considerably.

Mentioned here are just some of the renowned edge consequences of the undue use of HGH.
-- Acromegaly (as recounted in minutia above)
-- Premature death (in case of acromegaly)
-- Heart enlargement (due to extended use of HGH. Can't be reversed)
-- Low body-fluid sugar with risk of going into a diabetic coma
-- Excessive hair development all over the body
-- Excessive water retention
-- Liver damage
-- Thyroid damage

HGH from reputed manufacturers are protected if utilised under correct supervision, but they arrive with a little disadvantage; they are expensive. Many who take HGH without supervision purchase spurious goods that arrive at a smaller price. The edge consequences of indiscriminate use of HGH is awful, and it just gets poorer when counterfeit goods are used. Persons who share needles to inject themselves with HGH are at a high risk of transmission of blood-borne viruses (the deadliest and most widespread being the AIDS virus).

Beware of Beneficial Claims of HGH Made by Quacks
Many HGH marketers will make you accept as factual that HGH can explain a kind of human deficiencies. They assertion that taking HGH supplements will reinforce your immune scheme, augment broad hair on a bald head, construct sinew very fast making you gaze like a bodybuilder, boost your stamina and advance your sex life, advance your recollection like not ever before, advance your dream to perfection, set alight down fat without exercising or giving up your very well liked junk foods; this register can just proceed on and on. If all these assertions were factual, there would be no sickness round, every individual would have the flawless body without doing any thing and we would all be dwelling in a world where not anything could be made more perfect.

All these assertions are generally made to deal HGH supplements that are very costly and would not deal otherwise.

Are the dangers engaged in taking HGH supplements worth it? Is it not advisable to sustain a wholesome way of life with a correct diet and workout instead?





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HGH USAGE And FDA REGULATIONS

This post is about the FDA regulation regardness HGH.On previous post We talk about the benefit of using HGH aka human growth hormone .

HGH is a hormone which is manufactured and secreted by the pituitary gland. Levels of HGH decline as we age which sometimes causes related health issues including impaired growth. When HGH first became accepted as a medical treatment back in the 1950's, doctors obtained the hormone from human cadavers
until it was recently discovered that many batches of HGH were contaminated with agents that were responsible for causing Creutzfeldt-Jakob disease.

A biosynthetic form of HGH was created and has been available by prescription in the U.S. since 1985. The FDA has approved injected HGH to treat the following conditions:

Human Growth Hormone Deficiency
Turner's syndrome
Chronic renal insufficiency
Intrauterine growth retardation
Prader-Willi syndrome
Continued height deficit at puberty
Cachexia

There is no other medical usage of human growth hormone that has received FDA approval. nevertheless, many companies are interested in using HGH as a treatment for chronic fatigue syndrome, fibromyalgia and obesityas well as an athletic performance enhancer and as a treatment for certain anti aging therapies. As mentioned, the FDA has not approved HGH for these purposes and
is not likely to approve it until many clinical studies have been performed.

The decline in HGH associated with age contributes to increased visceral adipose tissue, decreased lean body mass, decreased bone mass, reduced exercise capacity, and thinning of the skin.1,3 The absence of HGH in those with GHD also is associated with an increase in cardiovascular risk factors.1 It is thought
that replacing human growth hormone will counteract the normal processes of aging. The purpose of using GH-related products as athletic performance enhancers is to achieve the same results–decreased body fat and increased muscle mass to possibly increase the level of performance.

To actually sell human growth hormone without a prescription or as a dietary supplement is illegal. Section 303F of the US Federal Food, Drug, and Cosmetic Act prohibits the distribution or possession with the intention of distributing human growth hormone without a medical condition that requires treatment. If someone does distribute or possess it illegally, he or she may face imprisonment and a fine.4

There are many homeopathic products available, however, that claim to provide a diluted form of human growth hormone. The sale of the homeopathic products as OTC products is legal, as stated in the Compliance Policy Guide from the FDA in Section 400.400. This document states that "a homeopathic drug is any drug labeled as homeopathic which is listed in the Homeopathic Pharmacopeia of the
United States (HPUS), an addendum to it, or its supplements."5 To be included in the HPUS, a drug must meet at least the following criteria: (1) it must be "safe and effective"; (2) it must be "prepared according to specifications of the General Pharmacy and relevant sections of the HPUS"; and (3) "submitted documentation must be in an approved format as set forth in the relevant sections of the HPUS and must include any data relevant to toxicity."6

Homeopathic Products

There are many oral homeopathic HGH (HGH) products available without a prescription. There also are HGH creams that penetrate the skin and go directly into the bloodstream. These creams are mainly used as anti aging products. Product manufacturers claim that this homeopathic form of HGH will stimulate the pituitary gland to release more HGH and that it is virtually free of side effects.

Enhancer Products (hGH Boosters)

These products are often called HGH secretagogues; they come in pill or powder form. They contain no GH, but, instead, amino acids that manufacturers claim cause the body to increase the production of GH. Common amino acids in these products are glutamine, arginine, ornithine, phenylalanine, and lysine. These substances are used in many sports supplements. Enhancer product manufacturers claim that they are virtually free of side effects and safe; however, limited studies have been done to prove their efficacy and safety. There is also an
enhancer available in a liquid form that is sprayed under the tongue, in the mouth, or in the nose. Again, no studies have been done to prove that this therapy is safe and effective.

The prices of these products range from $30 to $200 per month. Of note, many other OTC products claim to contain GH-related products but do not contain any hormone or ingredient to promote growth at all.

Potential Risks

human growth hormone use is not without potential risks and side effects. The prescription HGH products are associated with swelling of the hands and feet and musculoskeletal pain that is usually self-limiting or can be treated with analgesics.1,2 These products also are linked with the development of carpal tunnel syndrome.1,2 Thyroid function should be monitored, as well as glucose levels in diabetic and nondiabetic patients, because HGH can induce insulin resistance. Other conditions that have been associated with the prescription
products are gynecomastia, intracranial hypertension, and development of antibodies to the human growth hormone protein.2

Side effects, although rare, have been seen with use of the OTC products as well. They include elongation of the forehead, hands, and feet; overgrowth of the elbows or jaw; thickening of the skin; and insulin resistance.7 Because little information is available on the actual formulations contained in the OTC products, the full benefit and potential dangers of use are not yet known. The patient has a right to know the risks of using these products and that the possible benefits may not outweigh the risks.

What to Believe

Many companies use the prescription product (the injectable form of GH) data and apply it to the homeopathic OTC products. To do so is a violation of FDA and Federal Trade Commission regulations and can be considered misbranding. The FDA requires that information presented must be based on the exact product being sold. Pharmacists should be careful when looking at "supporting data."
Although these products sound good in advertisements, there is little and conflicting evidence that these products actually work.