Somatropin (Growth Hormone)

How it works

It replicates endogenous growth hormone, acting directly and via insulin-like growth factor-1 to stimulate linear bone growth, cell proliferation and protein, lipid and carbohydrate metabolism.

Prescribing in practice

• In Prader-Willi syndrome, severe obesity or severe respiratory impairment it carries a risk of sudden death, and it is contraindicated in active malignancy and during acute critical illness, so these must be excluded before and during treatment.
• It can unmask or worsen glucose intolerance, intracranial hypertension and slipped capital femoral epiphysis, and reduce thyroxine levels.
• It is given by subcutaneous injection and dosing is specialist-directed by weight or surface area; confirm against a children's formulary.

Monitoring

Monitor growth velocity, IGF-1, thyroid function and glucose, and review for headache or visual symptoms, hip or knee pain and, in at-risk children, respiratory status.

Counselling the patient

• Rotate injection sites to protect the skin.
• Report persistent headaches, vision changes, or a new limp or hip/knee pain.
• Attend regular growth and blood-test reviews so treatment can be adjusted.

Evidence & guidelines

NICE technology appraisal guidance supports somatropin for growth hormone deficiency and other defined paediatric growth disorders, with treatment overseen by paediatric endocrinology.