Medications for growth hormone disorders: Nursing pharmacology

The pituitary gland is a small gland located at the base of the brain, and it produces, stores, and releases various hormones that control other endocrine glands.

One of these is growth hormone, and disorders can arise when the pituitary produces too much or too little of it. Okay, so on one end of the spectrum, there’s growth hormone deficiency, which can occur in disorders like hypopituitary dwarfism, as well as Prader-Willi syndrome, Turner syndrome, and acquired immunodeficiency syndrome or AIDS-related wasting or cachexia.

Growth hormone deficiency is treated by replacing it using a recombinant human growth hormone, called somatropin. This medication can be injected subcutaneously or intramuscularly.

Once administered, it stimulates the proliferation of cartilage cells at the epiphyseal or growth plate of long bones, which results in bone growth.Now, the most common side effects of somatropin include skin reactions at the injection site, as well as headache, flu-like symptoms, fatigue, weakness, and aggressive behavior.

Some clients may experience gastrointestinal symptoms, such as nausea, vomiting, and pancreatitis. In addition, it may cause hypercalciuria, glucose intolerance, and ketosis, as well as endocrine side effects, such as hypothyroidism, and hypoadrenalism.

Lastly, some clients may develop antibodies against growth hormone.All right, now contraindications of somatropin include those with closed growth plates and in clients with neoplasms, acute respiratory failure, and those affected by Prader-Willi syndrome with obesity or sleep apnea.

Finally, somatropin should be used with caution during pregnancy and breastfeeding, as well as in newborns or elderly clients, and those with diabetes mellitus or hypothyroidism.

On the opposite end of the spectrum, we have disorders characterized by an excess of growth hormone, including acromegaly, which affects adults, and gigantism, which affects children.

Both disorders are treated using agents that interfere with growth hormone, such as octreotide, which is a somatostatin analogue that can be administered orally, subcutaneously, or intravenously; as well as bromocriptine, which is a dopamine receptor agonist that can be administered orally; and pegvisomant, which is a growth hormone receptor antagonist that is administered by subcutaneous injection.Once administered, both octreotide and bromocriptine suppress the release of growth hormone from the pituitary gland; while pegvisomant binds to the growth hormone receptors, preventing growth hormone from binding and exerting its effects.

Now, the most common side effects of these medications include headache, dizziness, fatigue, and weakness. Some clients may have depression, anxiety, and even seizures.In addition, clients may present with gastrointestinal side effects, such as abdominal pain, nausea, vomiting, diarrhea, or constipation; and octreotide may result in ileus and choleolithiasis; while bromocriptine may also cause dry mouth and gastrointestinal bleeding.

Also, some clients may experience cardiovascular symptoms, such as bradycardia, arrhythmia, and octreotide may cause hypertension, heart failure, and QT prolongation; while bromocriptine may cause hypotension and myocardial infarction.

Next, endocrine symptoms may arise, such as hypoglycemia, while octreotide may also cause hyperglycemia, ketosis, hypothyroidism, and galactorrhea.

Lastly, clients on octreotide or pegvisomant may develop injection site reactions; while bromocriptine may cause blurred vision and nasal congestion.All right, now octreotide and pegvisomant should be used with caution during pregnancy and breastfeeding, while bromocriptine is contraindicated.

In addition, precautions should be taken with children and elderly clients, and in those with renal disease or diabetes mellitus.

In addition, octreotide should be used with caution in clients with hypothyroidism; while bromocriptine should be used with caution in clients with cardiovascular, pulmonary, or hepatic disease, as well as in those with peptic ulcer disease or gastrointestinal bleeding.Bromocriptine should also be used cautiously in clients with pituitary tumors, dementia, and bipolar disorder.

Finally, bromocriptine is contraindicated in clients with migraines, uncontrolled hypertension, or severe peripheral vascular disease.All right, if your client is prescribed medication to treat growth hormone deficiency or excess, first perform a baseline assessment, including the client’s height, weight, and vital signs.

Then, review their most current laboratory test results, including insulin-like growth factor 1, or IGF-1 levels; IGF binding protein type 3, or IGFBP-3 levels; thyroid function tests, glucose level, as well as renal and hepatic function tests.If your client is prescribed somatotropin somatropin, obtain their X-ray or MRI results; on the other hand, if your client is prescribed octreotide, obtain their most recent ECG and gallbladder ultrasound results.Now, if a pediatric client is diagnosed with growth failure due to hormone deficiency and is prescribed somatropin, explain to your client’s caregivers that the medication is given to replace the missing growth hormone and promote normal growth patterns.

Instruct them to administer the medication subcutaneously once daily, at the same time each day, into the back of the upper arm, abdomen, or thigh, taking care to avoid injecting the medication within 2 inches of the child's navel.

When using an injection pen, teach them to store the medication in the refrigerator, and remind them to allow the medication to sit at room temperature before administration.

Then, show them how to place the medication cartridge into the pen, attach the needle, prime the cartridge, and select the correct dose on by turning the dose knob clockwise to the prescribed dosage.Make sure your client or their caregiver is able to correctly administer the medication using proper technique.

Remind them to rotate injection sites and to avoid any area that appears red, swollen, or bruised. Lastly, instruct them on appropriate disposal of used needles and cartridges.

Next, show the client and caregiver how to maintain a monthly growth record of the child’s height and weight, and instruct them to bring this with them at their follow-up appointments.

Also, let them know about side effects to report to their pediatrician right away, including lack of growth; symptoms of glucose intolerance, like increased hunger, thirst, or producing large amounts of urine; symptoms of hypothyroidism, like constipation, fatigue, or cold intolerance; as well as joint pain and swelling, which can be an indication that antibodies to growth hormone are developing.Now, if an adult client with acromegaly is prescribed octreotide, explain how this medication helps suppress the release of growth hormone.

If your client is prescribed the medication by intramuscular depot suspension, administer the medication into the intragluteal region every four weeks.

Be sure to rotate gluteal injection sites to avoid irritation, and stress the importance of returning every four weeks for their next injection.

On the other hand, if your client is prescribed octreotide orally, instruct them to take their medication with a full glass of water twice daily, once in the morning and once in the evening, on an empty stomach at least 1 hour before or 2 hours after a meal.

Then, let your client know about some side effects they may experience during therapy, and teach them to recognize symptoms of cholecystitis, such as pain in the right upper abdomen or right shoulder, or yellowing of the skin or whites of the eyes; symptoms of pancreatitis, such as severe abdominal or back pain, as well as nausea and vomiting; symptoms of glucose intolerance, including increased hunger, thirst, or urine production; symptoms of hypothyroidism, such as constipation, fatigue, or cold intolerance, or mood changes; and symptoms of arrhythmias, such as palpitations.

Lastly, advise your client to include foods that are rich in vitamin B12 in their diet while taking octreotide, such as meats, eggs, legumes, spinach, or broccoli.

Finally, when caring for a client with a growth hormone disorder, be sure to monitor them closely for side effects during therapy.

Evaluate for the desired therapeutic effect of growth pattern normalization for your pediatric client with growth hormone deficiency; and for decreased symptoms for your client with acromegaly.

All right, as a quick recap… Growth hormone disorders include growth hormone deficiency, which is treated with somatropin in order to replace the missing growth hormone and promote normal growth patterns; as well as excess of growth hormone, including acromegaly, which affects adults, and gigantism, which affects children, and can be treated with octreotide, bromocriptine, or pegvisomant, in order to interfere with growth hormone and reduce its effects.

Important side effects of these medications include decreased glucose tolerance and hypothyroidism. While caring for a client who is prescribed a medication affecting growth hormone, nursing considerations include performing a baseline assessment, as well as monitoring for side effects and for the desired therapeutic effect.

Finally, client teaching is focused on safe medication self-administration and learning to recognize side effects that should be reported to their healthcare provider.