GROWTH HORMONE

(SIMATOTROPIN, GH)
 Growth hormone is a peptide hormone
produced by anterior pituitary
 GH  growth at open epiphyses via
stimulation of insulin-like growth factor I (IGF-
I), Somatomedin C)
 GH  lipolysis in adipose tissue & growth of
skeletal muscle
 GH : a 191-amino acid peptide with 2
sulfhydryl bridges.
Pharmacokinetics
- Half-life of GH is 20 – 25 minutes
- Predominantly cleared by the liver
- Can be administered subcutaneously
- Peak levels occur in 2 – 4 hours
- Persisting in active blood levels for 36 hours
Pharmodynamics
- Increasing tissue uptake of both glucose and
amino acids
- Decreasing lipolysis
- Pharmacologic dose of GH  longitudinal
growth indirectly via somatomedin C
- Stimulates synthesis of somatomedin IGF-II 
promote uptake of sulfate into cartilage 
longitudinal growth.
- Growth hormone deficiency leads to inadequate
somatomedin production and short stature
 Clinical Pharmacology
A. Growth hormone deficiency
B. Growth hormone – Responsive states
C. Therapy for IUGR
Dosage
A. Children
- Treatment is begun with 0,025 mg/kg daily, can be
increased to a maximum of 0,045 mg/kg daily
- Somatropin injectable suspension (long acting of
rhGH) : administered subcutaneously in doses of 1.5
mg/kg monthly or 0,75 mg/kg twice monthly
- Children must be observed closely for slowing of
growth velocity
- Higher doses : Turner’s syndrome or chronic renal
insufficiency
- Chronic renal insufficiency : injection at least 3
hours after dialysis  reduce risk of hematoma.
B. Adults
- Dosage is lower than for children
- Treatment is begun at 0,2 mg, 3 times weekly ;
titrated upward gradually at intervals of 2 – 4
weeks to a maximum of 0,025 mg/kg/d (adult
under age 35) or 0,0125 mg/kg/d (adult over age
35)
- Somatropin :
- SC in doses of 0,2 – 0,4 mg/kg every 2 weeks
(men)
- for adult women : 0,4 – 0,6 mg/kg every
weeks (dose is higher than man).
 Toxicity and
Contraindication
- Intracranial hypertension (rare)
- Scoliosis during rapid growth
- Iurners syndrome : high risk for otitis media
- Hypothyroidism
- Pancreatitis
- Gynecomastia
 Nevus growth

 Adults tend to have more adverse effects from GH therapy

- Peripheral
- Myalgias
- Arthralgias (in hands and wrists)
- Carpal tunnel syndrome
- Proliferative retinopathy