Frequently Asked Questions
Various patients may have different questions from those listed below. If you are a parent of a child with growth hormone deficiency (GHD), you may want to refer to Some questions you might have in the Kids and teens section. If you have a question which is not answered by this Web site, please consult with your physician.
About growth hormone and growth hormone deficiency (GHD)
What is growth hormone?
How does growth hormone work?
What is growth hormone deficiency (GHD)?
What is GHDA?
Does growth hormone deficiency (GHD) make people ill?
Why does the doctor take an X-ray of my hand?
Getting started with Norditropin®
How do you take growth hormone?
What are Norditropin® cartridges (somatropin [rDNA origin] injection)?
What is Norditropin NordiFlex® (somatropin [rDNA origin] injection)?
Why does growth hormone have to be taken by injection?
Who will give the growth hormone injections?
How will I know how to give the injection?
How do I inject growth hormone?
Will the injection hurt?
I don't like needles. What can I do?
Why can't growth hormone be taken in larger amounts, fewer times a week?
How do I store my growth hormone therapy?
What happens if I leave my Norditropin NordiFlex® delivery pen in an area that gets warmer than 77°F?
Continuing therapy
What are the possible side effects of growth hormone therapy?
What if I miss or my child misses an injection?
Should an extra injection be given the next day after forgetting to take one?
What if too much growth hormone is injected?
Should growth hormone be taken if I have or my child has a cold or doesn't feel well?
How long will I/my child have to continue taking growth hormone?
How long will it take before we notice a difference in my child's height?
Will starting growth hormone therapy make my child feel different?
What can I do to help my child get the most out of growth hormone therapy?
About growth hormone and growth hormone deficiency (GHD)
What is growth hormone?
Hormones are chemical messengers that are produced in one part of the body and travel through the bloodstream to other parts of the body, where they deliver a message to cause some kind of change in the body. Growth hormone is a hormone that is produced by the pituitary (pi-TOO-i-tair-ee) gland, a pea-sized gland located just under the brain and behind the bridge of the nose. When the pituitary gland receives a message from the brain, it sends growth hormone via the bloodstream to the bones and other parts of the body, where it causes cell growth and division. The action of growth hormone in the bones, and especially in the spine and long bones of the legs, causes children to grow taller.
back to top
How does growth hormone work?
When growth hormone is released from the pituitary gland, it causes the release of a second growth-promoting hormone called insulin-like growth factor-1 (IGF-1).
Together, growth hormone and IGF-1 signal growth and/or increased number of cells in bone, muscle, and many other organs and tissues. The growth of the bones also requires that bone cells add minerals such as calcium and phosphate so that the bones become strong. Growing strong bones requires both growth hormone and IGF-1.
back to top
What is growth hormone deficiency (GHD)?
When the pituitary gland does not produce or release enough growth hormone into the bloodstream, it is called GHD. Children who have GHD and who do not take daily growth hormone therapy will not reach their full growth potential.
back to top
What is GHDA?
If an adult does not produce or release enough endogenous growth hormone into the bloodstream, then it is called adult growth hormone deficiency or GHDA. Adults who have GHDA and who do not take daily growth hormone therapy may experience changes in their body composition and metabolism.
back to top
Does growth hormone deficiency (GHD) make people ill?
Untreated GHD will not make a child ill, but it will prevent the child from reaching the full adult height he or she might if there were no GHD.
If GHD is not treated, the bones may not grow in length or strength and 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.
back to top
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.
back to top
Getting started with Norditropin®
How do you take growth hormone?
Norditropin® growth hormone is taken with daily injections using Norditropin NordiFlex® or with NordiPen® delivery pen and NordiPenMate® auto-insertion accessory. Norditropin NordiFlex® is prefilled with growth hormone. NordiPen® delivery pens hold Norditropin® cartridges. Norditropin NordiFlex® and NordiPen® delivery pens look like pens with a very short, very thin needle on one end.
Injections should be done daily (6 to 7 times per week) for example, at bedtime. Talk to your doctor about the best schedule for you.
back to top
What are Norditropin® cartridges (somatropin [rDNA origin] injection)?
Norditropin® cartridges contain growth hormone that has been produced by Novo Nordisk to be as close as possible to the growth hormone your own body makes naturally. The cartridges are loaded into NordiPen® delivery pens. Norditropin® cartridges come in 5 mg/1.5 mL (orange) and 15 mg/1.5 mL (green) formulations.
back to top
What is Norditropin NordiFlex® (somatropin [rDNA origin] injection)?
Norditropin NordiFlex® is the prefilled, multi-dose, liquid human growth hormone in a disposable pen that makes taking growth hormone simple. It is prefilled with growth hormone that has been produced by Novo Nordisk to be as close as possible to the growth hormone your own body makes naturally. Norditropin NordiFlex® comes in 5 mg/1.5 mL (orange), 10 mg/1.5 mL (blue), and 15 mg/1.5 mL (green) formulations.
back to top
Why does growth hormone have to be taken by injection?
One of the first things a lot of families 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 protein is eaten, the acids in the stomach break it down so it can be digested. If you took growth hormone by mouth—say as 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 hormone 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.
back to top
Who will give the growth hormone injections?
If your child is old enough, he or she might want to give him/herself the injections. If your child is not old enough, a parent or caregiver will inject the growth hormone. An adult can give him/herself an injection.
back to top
How will I know how to give the injection?
There are lots of materials available to explain how to give growth hormone injections. Each Norditropin® Starter Kit contains an instructional video and a booklet on using your Norditropin® product. Your doctor and nurse are the best sources of medical information. If you have questions after watching the video and reading the brochure, your doctor or nurse can answer them. You can also call us at 1-888-NOVO-444.
back to top
How do I inject growth hormone?
Always follow your doctor's and nurse's instructions for taking any medication, including growth hormone. The video in your Norditropin® Starter Kit gives clear directions on how to inject growth hormone using your Norditropin® product. Your doctor will probably tell you to inject the growth hormone every evening just before bedtime. And, after the injection, always dispose of the needles properly in the needle disposal container included in your Norditropin® Starter Kit.
back to top
Will the injection hurt?
NovoFine® disposable needles* were designed with comfort in mind, to help take some of the "ouch" out of injection. Their walls are very thin and they are electropolished and silicone coated to be extremely smooth. This means they go into the skin very easily with less friction and more comfort.
NordiPenMate® auto-insertion accessory works with NordiPen® delivery system to hide the needle so you don't even have to see it if you don't want to. NordiPenMate® also automatically inserts the needle at the touch of a button, helping to reduce pain perception compared with manual injection.
back to top
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®".
back to top
Why can't growth hormone be taken in larger amounts, fewer times a week?
Growth hormone is produced by the body throughout the day, every day, with most of it being produced at night. Taking injections every day most closely resembles how the body normally produces growth hormone. If you or your child took growth hormone only once a week, for example, he or she would not grow as tall as if injections were taken every day.
back to top
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.
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.
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.
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.
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® 15 mg delivery pen or Norditropin® cartridge 15 mg in the refrigerator.
back to top
Continuing therapy
What are the possible side effects of growth hormone therapy?
General Precautions
Remember, your doctor is the main source of information about you and your health. Please consult your doctor if you have any questions about your health or your medication.
Do not use Norditropin® if you have any of the following conditions: an allergy to phenol or any other ingredients in the medicine; active cancer or other forms of tumor; acute critical illness due to certain types of heart or abdomen surgery, trauma, or acute respiratory failure.
Children should not use Norditropin® if they have any of the following conditions:
closed epiphyses (closed bone growth plates), Prader-Willi syndrome with severe obesity, or Prader-Willi syndrome with significant respiratory impairment.
Be sure to tell your doctor if you have diabetes mellitus; have had cancer or other forms of tumor; are pregnant, planning to be pregnant or are breastfeeding; or if you have had a kidney transplant.
Be sure to tell your doctor about all medications you are taking especially if they are: a glucocorticoid medication such as hydrocortisone or cortisone acetate, thyroid hormone, insulin and/or oral diabetes medicines, drugs metabolized by the liver (for example, corticosteroids, sex steroids, anticonvulsants, cyclosporine), or oral estrogen replacement.
Adult height can be influenced if you are on Norditropin® for growth failure and at the same time using glucocorticoids or thyroid hormone.
If you are treated with insulin and/or oral diabetes medicines, the dose of your insulin/oral diabetes medicines may need to be adjusted.
Side effects are usually mild and temporary. Side effects may include headaches, muscle pain, joint stiffness, weakness, high blood sugar (hyperglycemia), sugar in your urine (glucosuria), swollen hands and feet due to fluid retention, and redness and itching in the area you inject.
If you have any of these symptoms, discuss them with your doctor.
If you have headaches, eyesight problems, nausea and/or vomiting, these may be symptoms of raised pressure in the brain. Contact your doctor right away.
In very rare cases children treated with somatropin have experienced pain in the hip or knee or a limp. These symptoms may be caused by a slippage of the growth plate in the hip (slipped capital femoral epiphysis).
Scoliosis (curvature of the spine) can occur in children who experience rapid growth. Because growth hormone increases growth rate, children should be monitored for progression of scoliosis.
Thyroid function tests should be performed periodically.
Skin lesions should be checked carefully for any unusual changes.
Talk to your doctor if you think you have any of these conditions.
back to top
What if I miss or my child misses an injection?
For optimal results, growth hormone injection should be taken every day. In most cases, however, missing an injection is not dangerous and you or your child will not get sick. 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.
back to top
Should an extra injection be given the next day after forgetting to take one?
If an injection is forgotten 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/give a double dose in the evening after missing one the night before, because the body will use only the normal daily amount anyway.
Realistically, there might be a day when you or your child will miss a dose, for example when your child is on a class trip or some other trip. Again, this is not dangerous. But, if injections are missed repeatedly, it can affect the success of treatment. And, if an injection is missed right before a checkup with the doctor, it can affect the results of tests and make it hard for the doctor to make decisions about the right growth hormone dose. So, remember to keep track of any missed doses. But even more important, remember to make sure you/your child receives your/his or her growth hormone injection every night.
Be sure to consult with your doctor after any change in your dosing regimen.
back to top
What if too much growth hormone is injected?
In most cases, if a little too much growth hormone is injected just once, it is probably not dangerous. However, it is important to keep to the prescribed dose. If too much growth hormone is injected or you have questions, contact your doctor.
back to top
Should growth hormone be taken if I have or my child has a cold or doesn't feel well?
Many people mistakenly believe that growth hormone injections should not be given when someone is sick, has a cold, or is taking antibiotics. Unless your doctor tells you otherwise, there is no reason whatsoever that growth hormone cannot be taken. You should make every effort to try not to miss any days. If you/your child has the flu or is taking other medicines, you/he/she should still always take the growth hormone injection. If you are hospitalized, due to an illness, be sure to tell the hospital that you take growth hormone injections.
It's important that you or your child continue to live as you or he or she normally would. All the usual childhood vaccinations should be given. If you or your child has a cold, you or he or she should take the growth hormone injection. If your child has the flu, he or she should take the growth hormone injection. If your child has a really bad fever and just doesn't feel up to it, your doctor might say it is okay to skip the injection, as long as it doesn't happen too often.
Be sure to consult with your doctor after any change in your dosing regimen.
back to top
How long will I/my child have to continue taking growth hormone?
This varies from individual to individual—not every child takes growth hormone therapy for the same length of time. It depends on what your child's physician thinks is best for your child. Your doctor or nurse can help answer this question for you.
A child who has been taking growth hormone may have to continue to take it as an adult, even when he or she has reached his or her final height. Growth hormone deficiency (GHD) in adults is a lifelong condition and needs to be treated accordingly; however, experience with patients aged 65 and older, and with patients with more than 5 years of treatment in adult growth hormone deficiency (GHDA), is limited.
Growth hormone has beneficial effects on bone health and fat tissue during adult life, even after adult height is reached. In some cases, growth hormone-deficient people may benefit from lifelong, low-dose therapy with growth hormone. You can discuss this with the endocrinologist when your adolescent is close to his or her adult height.
back to top
How long will it take before we notice a difference in my child's 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 the child grows (growth velocity). The response to treatment is usually greatest during the first year of treatment, when the child 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 many good things, it's worth waiting for.
After the first year of therapy, your child's growth rate will slow down. However, he or she will still continue to grow at a faster rate than before therapy began.
The age at which your child begins growth hormone therapy is important, too, because how much room children have for "catch-up" growth decreases as they get older. The age at which your child starts therapy is linked to the ability to reach normal adult height. The younger your child is at the start of therapy, the greater his or her catch-up growth will be. The sooner you begin therapy, the greater the chance that your child will reach his or her full potential adult height.
But don't worry if your child didn't start growth hormone therapy at a very young age. That probably means his or her growth was close to the normal range and that's why the growth hormone deficiency (GHD) was not discovered earlier. Growth hormone therapy usually will help "make up for lost time" and help your child catch up.
back to top
Will starting growth hormone therapy make my child feel different?
Occasionally, children may experience mild mood changes during the first few weeks of growth hormone therapy. Although the reason is not clear, it may be because your child has to get used to the idea of daily injections and regular checkups. However, mood changes seen with initiation of growth hormone therapy usually resolve when the results of therapy become evident. If persistent mood changes should happen to occur, be sure to talk to your child's doctor or nurse.
back to top
What can I do to help my child get the most out of growth hormone therapy?
One of the most important things you can do is make sure your child receives his or her Norditropin® injection every night. Be sure to keep regular appointments with the pediatric endocrinologist. The growth hormone dose will be carefully adjusted many times to ensure maximum benefit. Proper nutrition with healthy, well-balanced meals and plenty of exercise and fresh air are important too, and so is being there to support your child emotionally. And don't forget to remind your child that growing isn't just about how tall a person gets. Growing means trying new things and working hard to be the best you can be in school, in sports, music, art, or anything you choose to do.
back to top
*Needles may require a prescription in some states.
|
