Abnormalities of Growth (GH)

Lecture NO: 2nd MBBS

Dr Muhammad Ramzan
 GH abnormalities – the definition

• It refers to the conditions when level of GH is found to be

higher or lower than normal body requirements
• GH is important for children to grow or adults to have a
comfortable life
 Abnormalities of GH – Causes/ lesions
GH production and receptor binding

• GH deficiency and excess has a very important role of

this hormone in normal physiology
• Such disorders can result from lesions either in the :
• Hypothalamus or the pituitary affecting production or 1
• Target cells for Receptor binding
2
 GH abnormalities – Types
excess and deficiency

• GH may be secreted in excess or there can be deficiency

of GH with different clinical manifestations
• GH abnormalities can occur both in children and adults
• Excess of GH: Giantism in children and Acromegaly in adults
• Deficiency of GH: Dwarfism in children – Rare in adults
 Deficiency of GH – the types
Hereditary or acquired

• The manifestations of GH deficiency depends upon:

• The age of the of onset of the disorder or 1
• The cause whether it is heritable or acquired disease
• GH deficiency results Dwarfism in children
• GH deficiency is rare in adults
 Deficiency of GH in children
Dwarfism

• Deficiency of GH in children produces a condition called Dwarfism

• GH is secreted less than the body requirements
• Dwarfism is commonly associated with Panhypopituitrism
• It is a total failure of Pituitary in children
 Dwarfism – Special features 1
Appropriate proportion of body parts

• All the physical body parts like size of hands and feet
develop in appropriate proportion to each other but 1
• The rate of development is greatly reduced, ≥ 4 feet 2
• The affected child appears to be younger than his actual age
• A child at the age of 10 years may have body development
of a child aged 4 -5 – years 3
 Dwarfism – special features 2

• A dwarf individual may not pass through puberty as he

• never secretes sufficient quantity of Gonadotropins
• GH in these children may be sufficient but there will be
deficiency of IGF-1 – an active metabolite of GH 1
Dwarfism 0r growth retardation in children
 GH deficiency in Adults – is rare

• GH deficiency in adults is rare

• It results in reduction of muscle mass, visceral fat
deposition and osteoporosis
• Leads to abnormal lipid profile
 GH excess – Types. 2. (age)
In children and adults

• GH is secreted more than body requirements

• The effects of GH excess depend on the age of onset,
both in children and adults – 2 conditions
• Giantism or Gigantism : This condition occurs in children
when epiphysis are not Fused
• Acromegaly: when epiphysis are fused in adults
 GH excess in adults – Acromegaly
excess of GH/IGF-1

• Acromegaly results from excessive secretion of growth

hormone in adults with fused epiphysis
• It is usually the result of benign pituitary adenoma in
middle aged individuals
• Excessive secretion of GH leads to excessive generation
of IGF-1 - the mediator for the effects of GH
 Acromegaly – No ↑in height
↑in soft tissue /viscera

• There is no ↑ in height but soft tissue proliferation.

• There is Enlargement of bones of hands and feet with swelling
• Over growth of the Skull, lower jaw and bulging of forehead
• Prominent nose, thick lips and tongue
• ↑ in the size of the viscera like Liver and heart
Acromegaly –↑ in bone thickness and soft tissues
Acromegaly - Wide sole of foot
Acromegaly – Large skull, lower jaw, prominent nose
and bulging forehead
 GH excess in Children- Giantism
when epiphysis are not fused

• Giantism in children and adolescents occurs when

epiphysis are not fused
• Chronic GH secretion leads to linear growth of long
bones usually to 7- 9 feet
• Hyper secretion of GH is commonly associated with
hypogonadism and cause of non fusion of epiphysis
 Gigantism
7 feet 8 inches
Pituitary gland tumor
 Difference B/W Acromegaly and Giantism
Title Acromegaly
The nature Excess of GH in adults when
epiphysis are closed
Major action Increase in the size of short and
flat bones especially extremities
Size of skull and lower jaw Prominent skull, fore head and
overgrowth of lower jaw
Size of the Viscera Enlarged liver and heart
Muscle mass Increase in muscle mass
Metabolic role Promotion of proteogenesis-
Lipolysis and hyperglycemia
Hypogonadism Absent
Giantism
Excess of GH in children when epiphysis
are ununited
Over growth of the long bones of the
limbs especially lower limb
Over growth of long bones especially of
lower limb
No relative increase in size
Increase in bone mass
Promotion of GIT absorption of Ca++
Proteogenesis, Lipolysis and
Hyperglycemia
Present usually