Growth Hormone

Overview

Growth hormone is a natural chemical messenger your body makes. It comes from the pituitary gland, a small pea-sized gland at the base of the brain. In children, growth hormone helps bones grow longer, so they get taller. In adults, it helps keep muscles strong, bones healthy and body fat in balance. Sometimes the body makes too little growth hormone. Sometimes it makes too much. Both problems can be checked and treated, and most people do well with the right care.

Growth hormone problems are uncommon. Growth hormone deficiency affects only a small number of children and adults. Too much growth hormone is rare — doctors see just a few new cases per million people each year. Because these problems are uncommon, they are often found after other, more usual causes have been ruled out.

Anyone can be affected. Growth hormone deficiency can be present from birth, show up in childhood as slow growth, or develop in adult life after a head injury, brain surgery, radiation treatment or a problem with the pituitary gland. Too much growth hormone is usually caused by a non-cancerous growth (called an adenoma) on the pituitary gland. It is most often noticed in middle-aged adults, but it can affect children and younger adults too.

Symptoms

Common symptoms

• Feeling tired or low on energy most of the time
• Less muscle strength than before, or muscle that looks smaller
• More body fat, especially around the waist, even without eating more
• Feeling cold, or feeling that something is 'not right' without a clear reason
• Low mood, anxiety or poor sleep
• Weaker bones, so breaks happen more easily
• In adults with too much growth hormone: rings, shoes and gloves no longer fitting, a changing jaw or forehead, joint pain, snoring, headaches and vision changes

Symptoms in children

• Growing more slowly than other children of the same age
• Being much shorter than classmates, or moving down the growth chart over time
• Looking young for their age, with a round, 'baby-like' face
• Puberty starting later than expected
• Extra fat around the tummy with a small, soft build
• In babies: low blood sugar, which can show as being very sleepy, shaky, sweaty or feeding poorly
• With too much growth hormone: growing very fast and being much taller than expected for the family

Symptoms in older adults

• Changes that creep on slowly and can be mistaken for normal ageing
• Losing muscle and strength, with more falls or feeling unsteady
• More body fat around the middle
• Thin bones and a higher chance of fractures
• Tiredness, poor sleep and low mood
• With too much growth hormone: enlarged hands and feet, a deeper voice, thicker skin, snoring, high blood pressure or high blood sugar found on a routine test

Causes

Main causes

• Too little growth hormone: the pituitary gland may not form properly, may be injured, or may simply make less hormone for no clear reason
• Damage to the pituitary gland from a head injury, brain surgery or radiation treatment
• A non-cancerous growth (adenoma) on the pituitary gland — this is the usual cause of too much growth hormone
• Some genetic conditions that affect growth or the pituitary gland
• Problems around birth, such as a difficult delivery that reduced blood flow to the brain
• Inflammation of the pituitary gland (the body's immune system attacking it)
• Sometimes no cause is found, even after full testing

Risk factors

• A previous head injury or damage to the brain
• Past surgery or radiation treatment to the brain or pituitary area
• A known pituitary growth or other pituitary hormone problems
• Certain inherited (genetic) conditions
• A family history of pituitary problems
• Long-term use of steroid medicines, which can affect growth — ask your doctor about this, but never stop a prescribed medicine on your own

When to see a doctor

See a doctor urgently if:

• A child who has stopped growing or is falling far behind classmates
• Sudden or worsening vision problems, or a new, persistent headache
• Signs of low blood sugar in a child — shaking, sweating, confusion, extreme sleepiness
• Sudden changes in behaviour, mood or memory in an adult

Book a routine appointment if:

• You are worried about your child's height, growth speed or delayed puberty
• An adult notices hands, feet, jaw or forehead getting larger, or shoes and rings no longer fitting
• Long-lasting tiredness with loss of muscle, weight change or low mood
• A new habit of loud snoring, or high blood pressure or high blood sugar found on a test
• You have had a head injury, brain surgery or brain radiation in the past and feel unwell
• You simply feel something has changed and want it checked

Diagnosis

Your doctor will start by asking about your symptoms and your family history, and will examine you. For a child, the most useful first step is often accurate height measurements over several months, plotted on a growth chart, plus a look at the parents' heights. If a growth hormone problem seems possible, you will be referred to a specialist — a children's hormone doctor (paediatric endocrinologist) for children, or an adult hormone specialist (endocrinologist) for adults. The specialist arranges blood tests and sometimes a scan.

Tests that may be done

• Blood tests to measure growth hormone and a related hormone called IGF-1 (a marker of how much growth hormone your body has been making)
• A stimulation test: a medicine is given to prompt the pituitary gland, then blood samples are taken over a few hours to see how much growth hormone it releases
• A suppression test for too much growth hormone, where blood sugar is raised and hormone levels are measured
• Other hormone blood tests, because the pituitary gland controls several hormones
• An MRI scan of the brain to look at the pituitary gland
• A hand X-ray in children to check 'bone age' — how mature the bones are compared with the child's age
• Eye and vision checks if a pituitary growth is suspected

What to expect at your appointment

Testing usually takes a few visits and can feel drawn out. Some blood tests take several hours because samples are taken at set times, so bring a book, snacks if allowed, and someone with you if you can. Results are looked at together, not one test alone, so a normal or unclear result may lead to repeat testing. Waiting for answers is often the hardest part — ask your specialist when to expect results and who will explain them to you.

Treatment

Treatment depends on whether the body is making too little or too much growth hormone. For too little, the aim is to top up the hormone. For too much, the aim is to bring levels down and protect the heart, bones, joints and eyes. In both cases, a specialist leads the care, and treatment is checked with regular blood tests and visits.

Self-care at home

• Keep a simple record of symptoms, dates and questions to bring to appointments
• For a child, keep every height and weight measurement — patterns over time matter more than one reading
• Build regular sleep, balanced meals and gentle activity into the week
• Take any prescribed treatment exactly as your specialist advises, and never change or stop it on your own
• Ask for written information about your condition so you can read it again at home
• Bring someone with you to appointments to help remember what was said

Medical treatments

For too little growth hormone, specialists prescribe growth hormone replacement. It is given as a small injection under the skin, usually once a day, using a very fine needle. Your specialist sets the dose and adjusts it over time based on blood tests, growth in children, and how you feel. Children are usually reviewed every few months with height checks. For too much growth hormone, the first aim is to remove or control the pituitary growth that is causing it. Surgery is often the main treatment, and medicines or radiotherapy may be used alongside it or if surgery is not fully successful. Medicines may also be used to control the effects of too much hormone, such as high blood pressure or high blood sugar. Your specialist team will explain the options, the risks and benefits, and what fits your situation.

When is surgery considered?

Surgery is usually considered when a growth on the pituitary gland is causing too much growth hormone, or when a growth is pressing on the eyes or nerves and causing vision problems. A neurosurgeon (a brain surgeon) usually reaches the pituitary gland through the nose — there is no visible scar on the face. Some people need hormone replacement afterwards, because the pituitary gland may make less of other hormones. Your team will explain what to expect before and after the operation.

Living with this condition

Most people with a growth hormone condition live full, active lives. The main day-to-day tasks are keeping appointments, having blood tests when asked, and getting used to treatment routines. Children usually adapt quickly to growth hormone injections and can take part in sport, school trips and sleepovers with a little planning — for example, packing supplies and letting a trusted adult know what to do. Adults may need to pace themselves while treatment takes effect, and may notice changes over months rather than weeks.

Lifestyle tips

• Aim for regular sleep — growth hormone is mostly released during deep sleep
• Stay active in a way you enjoy: walking, swimming, cycling, or strength work with light weights if your doctor agrees
• Eat regular balanced meals with enough protein, calcium and vitamin D for bone health
• Limit alcohol and do not smoke — both are harder on bones, heart and blood sugar
• Protect your head: wear a helmet when cycling or riding, and a seatbelt in the car
• Keep a simple symptom diary so you can spot changes and share them at appointments

Diet and exercise

There is no special 'growth hormone diet'. A balanced pattern of eating — plenty of vegetables, fruit, whole grains, beans, dairy or calcium-rich alternatives, and protein at each meal — supports growth in children and muscle and bone in adults. Regular movement matters too. Children should be active most days, and adults should aim for a mix of walking or other aerobic activity and some gentle strength work. If your bones are thin or you have joint problems, ask your doctor or physiotherapist what is safe for you before starting something new.

Mental health and emotional wellbeing

Being shorter than others, or noticing your body change, can affect confidence and mood — for children and adults alike. Children may be teased, and some feel anxious about injections or hospital visits. Adults may feel frustrated by tiredness or by changes in how they look. These feelings are real and worth talking about. Tell your doctor if low mood, worry or sleep problems are building up. Ask about counselling or psychological support; many specialist clinics can arrange it. For anyone struggling with their mental health, contact your local crisis or mental health support service straight away if you feel unable to cope or have thoughts of harming yourself.

Prevention

Most growth hormone problems cannot be prevented, because they come from how the pituitary gland formed or from a growth on the gland. You did not cause this, and it is not down to anything you did or did not do as a parent. Some rarer causes can be reduced: protecting the head with helmets and seatbelts lowers the risk of head injury, and careful follow-up after brain surgery or radiation helps problems be spotted early.

Vaccines

There is no vaccine that prevents growth hormone problems. Staying up to date with routine vaccinations is still worthwhile, because infections and illness are harder on a body that is already under strain.

Screening programmes

Routine screening for growth hormone problems is not recommended for the general population. Instead, growth is checked at routine child health reviews, where height is measured and plotted over time — this is how slow growth is usually first noticed. Adults with a known pituitary problem, or who have had brain radiation or a head injury, are usually offered regular hormone checks by their specialist.

Complications

If left untreated

• In children: continuing short height, delayed puberty and lower bone strength into adult life
• In children: low blood sugar episodes, which can be dangerous if not treated
• In adults: loss of muscle, more body fat, thin bones and a higher chance of fractures
• In adults: ongoing tiredness, poorer sleep and lower quality of life
• With too much growth hormone: strain on the heart, high blood pressure and a higher chance of diabetes
• With too much growth hormone: painful joints, snoring and disturbed sleep (sleep apnoea), and changes to appearance
• If a pituitary growth grows large: pressure on the nerves to the eyes, which can affect eyesight

Long-term outlook

The outlook is genuinely good for most people. Growth hormone deficiency responds well to replacement treatment, and children treated early usually reach a height close to what their family pattern would predict. Too much growth hormone is rarer, but when it is found and treated, symptoms often improve over months and the risks to the heart, bones and eyes fall. Many people need long-term follow-up, and some need other hormone replacement too — but with a specialist team and regular checks, most people get back to the life they want. If you are worried at any point, raise it with your team; you are not being a nuisance.

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