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Many factors can influence growth, including genetics, nutrition, chronic diseases, medications, and other circumstances.

Often short stature is the only visible feature of growth hormone deficiency (GHD). That’s why your child has to undergo special tests before a diagnosis of GHD can be confirmed.

• Before testing happens
• Seeing a specialist and getting tested
• Whether GH therapy may be right for you or your child
• Keep asking questions

Before testing happens

Your healthcare professional may need to track your child’s height over a period of 6 to 12 months to evaluate his or her current growth rate. These measurements are plotted on a pediatric growth chart along with as many earlier measurements as possible. Your child’s healthcare professional or school may have records of yearly height and weight measurements.

Your healthcare professional may ask questions about your child’s current health, diet, appetite, and habits, and past illnesses and injuries. The healthcare professional may also ask for information about the mother’s pregnancy because it may provide a clue to the cause of the child’s short stature.

Your healthcare professional may also ask about your family history, including the health of other family members and the heights of parents, grandparents, siblings, and other close relatives. Be sure to mention any diseases or problems that run in the family, as well as about any history of early or late puberty (growth spurts and sexual development) in family members.

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Seeing a specialist and getting tested

Seeing a doctor called an endocrinologist—an expert on how hormones work—and getting tested may identify a medical reason behind slowed growth. Your doctor will review the test results and discuss treatment options with you and your child. Some tests you encounter may include:

Bone age X-rays

A bone age X-ray is done to determine the maturity (or “age”) of your child's bones, which may be different from your child’s chronological age.

In some short children, the maturity of the bones lags behind the child’s actual age, and the child is said to have a delayed bone age. Bone age may be useful in determining a short child’s growth potential, and this is one instance in which delayed maturity is a good sign. A 9-year-old boy who has a bone age of 7 years, for example, may have about 2 years more growth potential, or room to grow, than the average 9-year-old.

This is because the development of his bones is more like a 7-year-old boy’s than like a 9-year-old’s. However, this child’s delayed bone age may “catch up” to his chronological age in less than 2 calendar years, especially after he enters puberty.

Stimulation or “stim” testing

Stimulation testing for GH may be performed after other causes of growth failure have been ruled out. Because it’s difficult to measure the presence of GH directly, doctors may use GH stimulation tests to confirm growth hormone deficiency. These tests—also called provocative tests—use small amounts of a medication such as insulin, which is known to stimulate the body to make GH.

The amount of GH in the bloodstream is measured by taking one or more small blood samples over a period of time. This can be done in the healthcare professional’s office or during a brief hospital stay.

The test results should let your doctor know whether a deficiency of growth hormone is causing your child’s growth problem. If GH levels fail to rise as they should when the medication is given, growth hormone deficiency (GHD) is confirmed.

Lab tests

Other diagnostic tests, such as blood work, may help your doctor rule out other conditions and come up with a diagnosis. Ask your healthcare professional about what lab tests may be taken and what the results may mean.

An MRI

A test that uses a large magnet to create detailed digital pictures of areas inside the body—for example, if your doctor is checking for GHD, the pituitary gland. MRI stands for magnetic resonance imaging.

Is GH therapy right for you or your child?

Before starting growth hormone (GH) therapy, your healthcare professional may test to see if dietary changes and balancing other blood levels improve your child’s growth.

How much testing a child needs depends on what the healthcare professional finds at each step. A short child who is healthy and growing at a normal rate may be observed periodically throughout childhood, while a child whose growth has slowed may need more involved testing.

If the doctor finds that your child could benefit from GH therapy, he or she may recommend starting right away. If so, your child’s doctor may calculate how much GH is right for your child.

Doctors may prescribe Nutropin AQ^® [somatropin (rDNA origin) injection] or Nutropin^® [somatropin (rDNA origin) for injection] for children and teenagers with growth failure who:

• Do not make enough growth hormone on their own (pediatric growth hormone deficiency)
• Have chronic renal insufficiency—a slow loss of kidney function—and have not had a transplant (growth failure due to chronic renal insufficiency)
• Have Turner Syndrome (growth failure due to Turner Syndrome)
• Are not likely to grow to their potential adult height, as determined by a doctor, and whose bones are still able to grow (idiopathic short stature)

Doctors may prescribe Nutropin or Nutropin AQ for adults who:

• Have growth hormone deficiency that started either in childhood or as an adult due to brain surgery, radiation therapy, trauma, or diseases of the pituitary gland or the hypothalamus (adult growth hormone deficiency)

Ask your doctor about your or your child’s diagnosis.

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Keep asking questions

The GH treatment process can be confusing. To be sure you get all of your questions answered, write them down. Ask your doctor or nurse about:

• What to expect
• How long it may take to get test results
• If my child needs GH, what does that mean? Is there an illness?
• Where to find reliable information about GH
• What the test results mean

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IMPORTANT SAFETY INFORMATION

Nutropin and your safety:
Please read this important safety information carefully. Then, if you have any questions, talk with your doctor.

Nutropin is NOT for:

• Children and teenagers whose bones have finished growing
• Patients who have certain types of eye disease caused by diabetes
• Patients who have active cancer or any brain tumors
• Patients who are critically ill after open heart surgery or abdominal (stomach) surgery, are severely hurt, or have severe breathing problems
• Children and teenagers who have Prader-Willi syndrome and are very overweight or have trouble breathing
• Patients with a known sensitivity to benzyl alcohol, an ingredient in the liquid used to mix Nutropin Injection. Sterile water should be used when mixing Nutropin for newborns.

If any of these apply, talk to your doctor before you start taking Nutropin.

If you are about to start taking Nutropin, or are already taking it, be sure to tell the doctor who prescribed it:

• About ALL of the medications you are taking, including supplements
• If you have or develop a brain tumor
• If you are given any new medication, especially glucocorticoid steroids like hydrocortisone or prednisone
• If you are pregnant or if you become pregnant
• About ANY other condition or illness you have or develop

What are the possible side effects of Nutropin?
You may experience discomfort, soreness, or redness where Nutropin is injected.

Contact your doctor immediately if you experience:

• Ongoing injection site discomfort
• Curvature of the spine (scoliosis)
• Joint pain
• Puffy hands and/or feet (caused by fluid retention)
• Changes in vision, a bad headache, or nausea with or without vomiting
• Hip or knee pain
• A need to limp when you walk
• Pain in wrist (carpal tunnel)
• Allergic reaction

Be sure to inject Nutropin at a different recommended place on your body each time. Your doctor or nurse should supervise the first injection and provide training and instruction.

Your doctor is your primary source of information about your treatment.

Please see the full Prescribing Information for Nutropin and Nutropin AQ, available from your pharmacy and at www.nutropin.com, for more about Nutropin and safety.

Questions? Call the Nurse Hotline at 1-866-NUTROPIN (1-866-688-7674).

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