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What is growth hormone deficiency (GHD)?
A deficiency is not having enough of something. When the pituitary gland doesn't make enough growth hormone, it is called GHD. Children who have GHD and do not take daily growth hormone therapy might not reach their full growth potential.
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Will growth hormone deficiency (GHD) make me ill?
No, it will not make you ill, but it will prevent you from reaching the full adult height you would achieve if you did not have GHD. Most children (and their parents) want to reach their full potential in everything they do—including growth.
If GHD is not treated, the bones will not grow in length or strength which may lead to weak bones (osteoporosis) during adult life. Also, unused food energy will be stored as increased fat. Excess body fat may be a risk factor for heart disease and diabetes during adult life.
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Testing for growth hormone deficiency (GHD)
How will I know I have growth hormone deficiency (GHD)?
Only a doctor who is a specialist in GHD can tell for sure if you have GHD. If you or your parents think you might be growing too slowly, it is important for you to be seen by a specialist to find out if you have GHD. The doctor will first ask many questions about your health and growth history and the health and growth history of your family. The specialist will examine you and measure your height and might even examine your parents. The doctor might want to see how you grow over the next few months before starting testing. At some point, though, you will have blood tests and X-rays of your hand taken.
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What kinds of blood tests will I have?
You will have many blood tests taken, including a Stimulation Test (Stim Test). This is an important test used to help diagnose GHD. It is important because the levels of growth hormone in a person's blood change all the time and can be very low and difficult to measure, even when the person does not have GHD. There are different types of Stim Tests. Some are able to measure the level of growth hormone when it is at its highest level, for example after sleep or exercise, since both of these activities increase the level of growth hormone. Another type uses a medicine to make the pituitary gland produce a large amount of growth hormone. If the pituitary does not produce growth hormone in response to this "stimulation," it is a sign that the person has GHD.
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Why does the doctor take an X-ray of my hand?
The doctor will take an X-ray of your hand because it shows your "bone age" and can help predict your final adult height. Bone age is more important than your actual age in years because it can help to show if you really do have GHD and if you still have room for "catch-up" growth. Catch-up growth means you still have room to grow and growth hormone therapy may help you reach the adult height you would if you did not have a deficiency of growth hormone.
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Getting started with Norditropin®
What is Norditropin®?
Norditropin® is growth hormone that has been produced by Novo Nordisk to be as close as possible to the growth hormone your own body makes naturally. back to top
Why do I have to take growth hormone by injection?
One of the first things a lot of kids and teens find out about growth hormone is that it has to be injected. Growth hormone is a "peptide." This means it is similar to a protein, like the protein we eat in certain foods. When you eat protein, the acids in your stomach break it down so it can be digested. If you took growth hormone by mouth—say a pill or a liquid—the same thing would happen. The stomach would break it down and digest it. In a "broken-down" state, it would not be able to help you grow. Additionally, because the growth molecule is so big, the stomach wouldn't be able to absorb it, even if it were broken down. Growth hormone has to be injected—so that it can work properly.
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Who will give me my growth hormone injection?
That depends. If you are old enough, you can inject yourself. If you are not old enough, your mother or father or another caregiver will inject your growth hormone.
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How will I know how to give the injection?
There are a lot of materials available to explain how to take your growth hormone injection. Each Norditropin® Starter Kit from Novo Nordisk contains an instructional video and booklet on using Norditropin®. If you still have questions after watching the video and reading the brochure, your nurse or doctor can answer them. Your doctor and nurse are always the best source of medical information.
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How should I inject my growth hormone?
Always follow your doctor's and nurse's instructions for taking any medication, including your growth hormone. The video in your Norditropin® Starter Kit gives clear directions on how to use your Norditropin® products. Your doctor will probably tell you to inject the growth hormone every evening just before bedtime. And, after you take your injection, always dispose of the needles properly. Unscrew the needle, then carefully put the needle in the sharps container included in your Norditropin® Starter Kit.
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Will the injection hurt?
NovoFine® disposable needles* were designed with comfort in mind, to help take some of the "ouch" out of injections. The walls of NovoFine® needles are very thin and they are electropolished and silicone coated to be extremely smooth. This means they go into your skin very easily, with less friction and more comfort. And NordiPenMate® auto-insertion accessories work with NordiPen® delivery systems and hide the needle. That means you don't even have to see it if you don't want to.
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I don't like needles. What can I do?
If you do not like needles, there is a solution that hides the needle during injections. NovoFine® Autocover® needle is available for use with Norditropin NordiFlex®, the injection pen that is used to inject Norditropin®. NovoFine® Autocover® needle keeps the needle hidden so you do not have to worry about seeing the needle during the injection.
Please make sure your prescription reads "NovoFine® Autocover®."
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Why can't I take a larger amount of growth hormone fewer times a week?
Growth hormone is produced by the body all through the day with most being produced at night. Taking injections every day is closest to how our bodies normally work. Please speak to your doctor regarding individual dosing requirements.
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Why can't I just take growth hormone as a pill?
Growth hormone is similar to a protein, like the protein in some foods. Acids in the stomach break down proteins so they can be digested. If you took growth hormone as a pill or a liquid, your stomach would break it down and digest it. In this broken down state, it could not help you grow. Additionally, because the growth molecule is so big, the stomach wouldn't be able to absorb it, even if it were broken down. Growth hormone has to be injected so that it can work properly.
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How do I store my growth hormone therapy?
Storage flexibility for Norditropin NordiFlex®
All Norditropin® products must be refrigerated prior to use. Do not freeze. After initial use, Norditropin NordiFlex® 5 mg and 10 mg pens can either be stored outside of the refrigerator (at up to 77°F) for use within 3 weeks, or in the refrigerator (between 36°F and 46°F) for use within 4 weeks. These storage flexibility guidelines also apply to Norditropin® cartridge 5 mg.
Norditropin NordiFlex® 15 mg pen must always be refrigerated (between 36°F and 46°F)—both prior to and after the initial injection—for use within 4 weeks. These guidelines for continuous refrigerated storage also apply to Norditropin® cartridge 15 mg.
Storage flexibility for Norditropin® cartridge 5 mg
All Norditropin® products must be refrigerated prior to use. Do not freeze. After initial use however Norditropin® cartridge 5 mg can either be stored outside of the refrigerator (at up to 77°F) for use within 3 weeks, or in the refrigerator (between 36°F and 46°F) for use within 4 weeks. These storage flexibility guidelines also apply to Norditropin NordiFlex® 5 mg and 10 mg pens.
Norditropin® cartridge 15 mg must always be refrigerated (between 36°F and 46°F)—both prior to and after the initial injection—for use within 4 weeks. These guidelines for continuous refrigerated storage also apply to Norditropin NordiFlex® 15 mg pens.
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What happens if I leave my Norditropin NordiFlex® delivery pen in an area that gets warmer than 77°F?
If you leave your Norditropin NordiFlex® 5 mg or 10 mg delivery pen, or your Norditropin® cartridge 5 mg, in an area that gets warmer than 77°F, call your healthcare provider or NordiCare® representative at 1-888-NOVO-444 before you use it again. They will let you know what to do. Remember that Norditropin NordiFlex® 15 mg delivery pen and Norditropin® cartridge 15 mg must always be refrigerated. Call your healthcare provider or NordiCare® representative right away if you forget to put your Norditropin NordiFlex® 15 mg delivery pen or Norditropin® cartridge 15 mg in the refrigerator.
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Continuing therapy
What if I forget to take my injection?
For best results you should take your injection every day. In most cases though, you won't get sick if you miss a day. You should keep a record of missed doses and share it with your doctor.
Be sure to consult with your doctor after any change in your dosing regimen.
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Should I take an extra injection the next day after forgetting to take one?
If you forget to take the injection one night, don't worry about it, but make a note of it. Then just take your regular evening dose as usual. You should not take a double dose in the evening after missing one the night before, because the body will only use the normal daily amount anyway. Realistically, there might be a day when you will miss a dose, maybe while you are on a class trip or some other trip. Again, this is not dangerous to you. But if you miss injections repeatedly, it can affect the success of your treatment. And, if it happens right before a check-up with your doctor, it can affect the results of tests and make it hard for the doctor to make decisions about the growth hormone dose that's right for you. So, remember to keep track of any missed doses. But even more important, remember to take your growth hormone injection every night.
Be sure to consult with your doctor after any change in your dosing regimen.
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What if I inject too much growth hormone?
It is important to take your medication exactly as your doctor has directed. If too much growth hormone is taken, tell your doctor.
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Should I take my growth hormone if I have a cold or don't feel well?
Many people mistakenly believe that you should not take growth hormone injections when you are sick or have a cold or are taking antibiotics. Unless your doctor tells you otherwise, there is no reason whatsoever that you cannot take your growth hormone. You should make every effort to try not to miss any doses. If you have the flu or are taking other medicines, you should still always take your growth hormone. It's important to live as you normally do with growth hormone therapy. If you have a cold, take your growth hormone. If you have the flu, take your growth hormone. If you have a really bad fever and just don't feel up to it, your doctor might say it is okay to skip your injection once, as long as it doesn't happen too often. It is very, very important that you take your growth hormone every day.
Be sure to consult with your doctor after any change in your dosing regimen. If you are hospitalized due to illness, be sure to tell the hospital that you take growth hormone injections.
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How long will it take before I see a difference in my height?
The effects of growth hormone therapy are different in different children and teens. Most of the time, the results are very dramatic. With growth hormone therapy, there may be a big increase in how fast you grow (your growth velocity). The response to treatment is usually greatest during the first year of treatment when you may grow anywhere from 2 to almost 6 inches. You have to be patient, though, because you won't see big changes overnight. It may take 6 months before you see substantial change. But like all good things, it's worth waiting for. After the first year of therapy, your growth rate will slow down. But you will still continue to grow at a faster rate than before you started therapy. The age you begin growth hormone therapy is important, too, because how much room you have for "catch-up" growth decreases as you get older. The age at which you start therapy is linked to the ability to reach normal adult height. The younger you are when you start therapy, the greater your catch-up growth will be. The sooner you begin therapy, the greater the chance that you will reach your full potential adult height. But don't worry if you didn't start growth hormone therapy at a very young age. That probably means your growth was close to the normal range, and that's why your GHD was not discovered earlier. Growth hormone therapy usually will help you catch up.
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How long will I have to continue taking growth hormone?
Not everyone takes growth hormone therapy for the same length of time. It depends on what your doctor thinks is best for you. Your doctor or nurse can best answer this question for you.
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What can I do to get the most out of my growth hormone therapy?
The most important thing to remember is to take your injection every night, the way your doctor or nurse tells you to. Eating healthy, well-balanced meals is important to how you grow. Getting plenty of exercise and fresh air is also important. Remember, growing isn't just about how tall we get. Growing means trying new things and working hard to be the best you can be in school, sports, music, art, science, or anything you choose to do.
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If you have questions that are not listed above, you may want to refer to the FAQs in the Parents, caregivers & adult patients section. If you have a question and can't find the answer on this Web site, remember to ask your doctor.
*Needles may require a prescription in some states.
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