- Growth hormone, primobolan, and leuplin, their respective roles and indications -.
Do you ever feel that your child is not tall enough or is growing slower than others around him or her?
At Ikejiri-Ohashi Sera Clinic's outpatient growth promotion clinic, physicians administer drug therapy based on scientific evaluation and clear criteria.
There are three main types of drug therapy, each with different mechanisms of action and indications:
- Growth hormone (GH)
- Primobolan (methenolone acetate)
- Leuplin (GnRH agonist)
This article will provide a detailed explanation of the purpose, indications, and precautions for use of each drug.
1] Growth Hormone (GH: Growth Hormone)
Mechanism of action
Growth hormone promotes "vertical growth" (height increase) by acting on the liver and bones to produce IGF-1 (insulin-like growth factor) and promote epiphyseal growth.
Purpose of use
- Increase the rate of growth (spurt acceleration)
- Improvement of final height
Criteria for use
- Bone age: boys ≤ 13 years old / girls ≤ 11 years old is desirable
- The epiphyseal line (growth plate) must not be closed
- A physician will evaluate growth hormone secretion (e.g., stimulation test) to determine if it is necessary
Contraindications
- post-apophyseal closure
- When there is an active malignancy
- Severe diabetic retinopathy, etc.
Primobolan (methenolone acetate)
Mechanism of action
The drug has mild androgenic effects and provides a direct growth stimulus to bone.
It also has an adjunctive role in enhancing sensitivity during growth hormone therapy.
Purpose of use
- Triggering of growth spurts (especially in boys with a tendency toward constitutional delayed puberty)
- Combined use of growth hormone alone when growth is weak
Criteria for use
- Bone age: boys ≤ 14 years old / girls ≤ 12 years old is desirable
- Cases with strong bone age delay or no growth spurt
- Below average height and insufficient final height
Precautions for use
- For male hormone-based drugs,Administering to girls is a prudent decision.You need to
- Regular evaluation (bone age, blood hormones) is important
3] Leuplin (GnRH agonist)
Mechanism of action
Suppresses the hypothalamic-pituitary-gonadal axis and stops the production of sex hormones (estrogen and testosterone) by suppressing LH/FSH secretion.
This delays the closure of the epiphyseal line and prolongs the "period of time during which it can grow (transverse axis).
Purpose of use
- Reduce the progression of puberty
- Inhibits bone age progression and improves final height
Criteria for use
- Bone age: Ideal for boys ≤ 12 years / girls ≤ 10 years
- Secondary sexual characteristics have already begun (breast development, enlarged testes, etc.)
- Early progression of bone age and large difference between current height and FHA (final height age)
Precautions and concomitant therapy
- Because Leuplin alone may reduce the growth rate,Effective in combination with growth hormonein some cases
- Considered when there is rapid bone age progression or when the final height projection does not reach the target
Contraindications
- If the epiphyseal line is already closed
- History of testicular or hormone-sensitive tumors
Drug Selection Practices
In treatment, not only are single agents used tocombined therapyis also done on a situation-by-situation basis:
| pattern | situation | treatment |
|---|---|---|
| Slow growth rate and slow bone age | Men who don't come in spurts, etc. | Primobolan alone or +GH |
| Rapid bone age progression, with puberty progression | Significantly low FHA | Leuplin + GH |
| Sluggish growth hormone response | Insufficient effect with single GH | GH + Primobolan |
What we can do at Ikejiri-Ohashi Sera Clinic's outpatient growth promotion clinic.
The clinic offers the following
- Accurate measurement of height, weight, and bone age
- Creation of growth curves and final height projections
- Hormone blood collection and growth hormone load testing
- Clear treatment decisions by physicians and selection of drugs to be used
- Added to drug therapy,Total support for exercise and nutrition
Summary
Pharmacotherapy in growth promotion must be appropriately selected based on both the amount of growth (vertical axis) and the time available for growth (horizontal axis).
To that end,Important to comprehensively evaluate bone age, secondary sexual characteristics, and growth rateIt is.
If you are concerned about your child's future growth, please consult our "Growth Promotion Outpatient Clinic".
We will help you maximize your final height potential.