The testing process.
The procedures to expect.
The IGF-1 screening to ask for.
If you and your child's doctor have discussed short stature, and agree that it may require a more expert opinion, he or she will refer you to a specialist called a pediatric endocrinologist. And because arriving at an accurate diagnosis can be complex, it may take several trips to the specialist before a specific short stature disorder is diagnosed.
To reach a diagnosis, the doctor is likely to do the following things:
- Measure your child
- Ask questions about family history
- Rule out the prospect of other conditions that might affect height, such as poor nutrition, underactive thyroid, or chronic treatment with steroids
After doing the above, your doctor may then
- Conduct several blood tests to determine levels of growth hormone
IMPORTANT: Your doctor should be testing your child for both growth hormone and IGF-1 in order to reach an informed diagnosis. IGF-1 screening measures blood levels of IGF-1, which is an important hormone for growth. Don't be afraid to ask your child's doctor about IGF-1 screening during the diagnostic workup.
The GH stimulation test
Based on the result of your child's IGF-1 screening, your child may then be given a growth hormone stimulation test. The two results together will provide your doctor with a more complete picture from which to make an accurate diagnosis.
During a GH stimulation test
- A sample of blood is drawn after your child has fasted for 10-12 hours.
- Then, under close medical supervision, your child is given an intravenous solution (L-dopa or arginine), which stimulates the pituitary gland to produce growth hormone and has been known to make children feel sleepy or nauseous. You can help calm your child by assuring her that these are perfectly normal reactions and that they will not last long.
- Next, blood samples are drawn at timed intervals and GH levels are tested. The entire process may take several hours. It's a good idea to prepare your child for a lengthy office visit and bring along reading material to make the time pass more quickly.
- Responses to GH testing vary and interpreting results can be complex; thus, GH testing is not consistently reliable in determining if patients need GH therapy.
If IGF-1 is exceptionally low but GH is normal
If your child's growth hormone levels turn out to be normal or high but IGF-1 levels are exceptionally low, your doctor may diagnose your child as having severe primary IGFD. If your doctor already has performed a GH stimulation test on your child, talk to your doctor about IGF-1 screening.
If a GH stimulation test has been conducted but IGF-1 levels have not been checked
Your child's growth hormone levels tell only part of his or her growth story. Your child's IGF-1 levels should also be checked. IGF-1 levels are checked with a simple blood test. Be sure to talk to your child's doctor about obtaining an IGF-1 screening.
A checklist for parents—what you can do to help
- Assure your child. To a child, having blood drawn can be scary. Remember to assure your child that the testing process doesn't last long and, more importantly, that it's necessary so that your child's doctors can figure out why he or she isn't growing properly.
- Be aware of gender differences. A study discovered that significantly fewer girls than boys were referred to a specialist for further evaluation, likely due to social pressures that imply short stature is a more significant problem in boys than girls. There are many reasons that a child may have short stature, including underlying conditions such as celiac disease, so continue to advocate for your child, girl or boy, until you and the doctor are satisfied that an accurate diagnosis has been reached.
- Ask about IGF-1 screening. Talk to your child's doctor about screening for IGF-1 deficiency. This is important for any child being tested and is especially important for those who have been taking growth hormone therapy and have not responded during 6 to 12 months of treatment. Remember: don't be afraid to talk to your child's doctor about IGF-1 screening. You both want what's best for your child and what's best begins with an accurate diagnosis.
Be an advocate for your child. Talk to your doctor about having your child screened for severe primary IGFD, and about a therapy that treats it, Increlex® (mecasermin [rDNA origin] injection).
Who should not use INCRELEX?
Your child should not take INCRELEX if your child: has finished growing, has cancer, has other causes of growth failure, or is allergic to mecasermin or any of the inactive ingredients in INCRELEX. Your child should never receive INCRELEX through a vein.
What should I tell my child’s doctor before my child starts INCRELEX?
Tell your child's doctor about all of your child's health conditions, including if your child has diabetes, kidney problems, liver problems, allergies, curved spine (scoliosis), or is pregnant or breast-feeding.
Tell your child’s doctor about all the medicines (prescription and nonprescription), vitamins, and herbal supplements your child takes. Especially tell your child’s doctor about insulin or other anti-diabetes medicines; a dose adjustment may be needed.
What are possible side effects of INCRELEX?
INCRELEX may cause the following side effects, which can be serious:
- Low blood sugar (hypoglycemia). Only give your child INCRELEX right before or right after (20 minutes on either side of) a snack or meal to reduce the chances of hypoglycemia. Do not give your child INCRELEX if your child is sick or cannot eat. Signs of low blood sugar are: dizziness; tiredness; restlessness, hunger, irritability, trouble concentrating, sweating, nausea, and fast or irregular heartbeat. Severe hypoglycemia may cause unconsciousness, seizures, or death. People taking INCRELEX should avoid participating in high risk activities (such as driving) within 2 to 3 hours after an INCRELEX injection.
- Enlarged tonsils. Signs include: snoring, difficulty breathing or swallowing, sleep apnea (a condition where breathing stops briefly during sleep), or fluid in the middle ear.
- Increased pressure in the brain (intracranial hypertension). INCRELEX, like growth hormone, can sometimes cause a temporary increase in pressure within the brain. Symptoms include persistent headache and nausea with vomiting.
- A bone problem called slipped capital femoral epiphysis. This happens when the top of the upper leg bone (femur) slips apart from the rest of the bone. Seek immediate medical attention if your child develops a limp or has hip or knee pain.
- Worsened scoliosis (caused by rapid growth).
- Allergic reactions. Your child may have a mild or serious allergic reaction with INCRELEX. Call your child's doctor right away if your child gets a rash or hives. If hives do occur, they generally appear minutes to hours after the injection and may sometimes occur at numerous places on the skin. Get medical help immediately if your child has trouble breathing or goes into shock, with symptoms like dizziness, pale, clammy skin, and/or passing out.
INCRELEX can cause reactions at the injection site including: loss of fat, increase of fat, pain, redness, or bruising, which can be avoided by changing the injection site at each injection.
These are not all the side effects of INCRELEX. Call your child’s doctor if your child has side effects that are bothersome or that do not go away. You are encouraged to report negative side effects of prescription drugs to the FDA. Visit www.fda.gov/medwatch, or call 1-800-FDA-1088.
What is INCRELEX?
INCRELEX is a prescription medicine used to treat children who are very short for their age because their bodies do not make enough insulin-like growth factor-1 (IGF-1). This condition is called severe primary IGF-1 deficiency. INCRELEX should not be used instead of growth hormone. INCRELEX has not been studied in children under 2 years of age.
Who should not use INCRELEX®?
Your child should not take INCRELEX if your child: has finished growing (the growth plates at the end of the bones are closed); has cancer; has other causes of growth failure; OR is allergic to mecasermin or any of the inactive ingredients in INCRELEX. INCRELEX has not been studied in children under 2 years of age and should never be used in newborns. Your child should never receive INCRELEX through a vein.
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