Test of testicular function, prolonged stimulation test
▶BY INTRAMUSCULAR INJECTION
▶Child: 1500 – 2000 units twice weekly for 3 weeks
Hypogonadotrophic hypogonadism
▶BY INTRAMUSCULAR INJECTION
▶Child: 1000 – 2000 units twice weekly, adjusted
according to response
Undescended testes
▶BY INTRAMUSCULAR INJECTION
▶Child 7–16 years:Initially 500 units 3 times a week,
adjusted according to response to up to 4000 units
3 times a week continue for 1 – 2 months after testicular
descent
▶Child 17 years:Initially 1000 units twice weekly,
adjusted according to response to up to 4000 units
3 times a week continue for 1 – 2 months after testicular
descentlUNLICENSED USEUnlicensed in children for test of
testicular function.
lCONTRA-INDICATIONSAndrogen-dependent tumours
lCAUTIONSAsthma.cardiac impairment.epilepsy.
migraine.prepubertal boys (risk of premature epiphyseal
closure or precocious puberty)
lSIDE-EFFECTSFatigue.fever.fluid retention.
gynaecomastia.headache.hypersensitivity.mood altered
.oedema.ovarian hyperstimulation syndrome.skin
reactions.sodium retention
lRENAL IMPAIRMENTUse with caution.
lMEDICINAL FORMS
There can be variation in the licensing of different medicines
containing the same drug.
Powder and solvent for solution for injection
▶Pregnyl(Merck Sharp & Dohme Ltd)
Chorionic gonadotrophin human 1500 unitPregnyl 1 , 500 unit
powder and solvent for solution for injection ampoules|
1 ampouleP£ 2. 12 e
Chorionic gonadotrophin human 5000 unitPregnyl 5 , 000 unit
powder and solvent for solution for injection ampoules|
1 ampouleP£ 3. 15 e
6.4 Growth hormone disorders
PITUITARY AND HYPOTHALAMIC HORMONES
AND ANALOGUES›HUMANGROWTHHORMONES
Somatropin
(Recombinant Human Growth Hormone)
lINDICATIONS AND DOSE
Gonadal dysgenesis (Turner syndrome)
▶BY SUBCUTANEOUS INJECTION
▶Child: 1. 4 mg/m^2 daily, alternatively
45 – 50 micrograms/kg daily
Deficiency of growth hormone
▶BY SUBCUTANEOUS INJECTION, OR BY INTRAMUSCULAR
INJECTION
▶Child: 23 – 39 micrograms/kg daily, alternatively
0. 7 – 1 mg/m^2 daily
Growth disturbance in children born small for gestational
age whose growth has not caught up by 4 years or later|
Noonan syndrome
▶BY SUBCUTANEOUS INJECTION
▶Child 4–17 years: 35 micrograms/kg daily, alternatively
1 mg/m^2 dailyPrader-Willi syndrome, in children with growth velocity
greater than 1 cm/year, in combination with energy-
restricted diet
▶BY SUBCUTANEOUS INJECTION
▶Child: 1 mg/m^2 daily, alternatively 35 micrograms/kg
daily; maximum 2. 7 mg per day
Chronic renal insufficiency (renal function decreased to
less than 50 %)
▶BY SUBCUTANEOUS INJECTION
▶Child: 45 – 50 micrograms/kg daily, alternatively
1. 4 mg/m^2 daily, higher doses may be needed, adjust if
necessary after 6 months
SHOX deficiency
▶BY SUBCUTANEOUS INJECTION
▶Child: 45 – 50 micrograms/kg daily
DOSE EQUIVALENCE AND CONVERSION
▶Dose formerly expressed in units; somatropin 1 mg:
3 units.lUNLICENSED USENot licensed for use in Noonan
syndrome.
lCONTRA-INDICATIONSAvoid injections containing benzyl
alcohol in neonates.evidence of tumour activity
(complete antitumour therapy and ensure intracranial
lesions inactive before starting).not to be used after renal
transplantation.not to be used for growth promotion in
children with closed epiphyses (or near closure in Prader-
Willi syndrome).severe obesity in Prader-Willi syndrome.
severe respiratory impairment in Prader-Willi syndrome
lCAUTIONSDiabetes mellitus (adjustment of antidiabetic
therapy may be necessary).disorders of the epiphysis of
the hip (monitor for limping).history of malignant disease
.hypothyroidism—manufacturers recommend periodic
thyroid function tests but limited evidence of clinical value
.initiation of treatment close to puberty not
recommended in child born small for corrected gestational
age.papilloedema.relative deficiencies of other pituitary
hormones.resolved intracranial hypertension (monitor
closely).Silver-Russell syndrome
lINTERACTIONS→Appendix 1 : somatropin
lSIDE-EFFECTS
▶Common or very commonHeadache.lipoatrophy
▶UncommonArthralgia.carpal tunnel syndrome.fluid
retention.gynaecomastia.idiopathic intracranial
hypertension.myalgia.paraesthesia
▶Rare or very rareHyperglycaemia.hyperinsulinism.
hypothyroidism.osteonecrosis of femur.pancreatitis.
slipped capital femoral epiphysis
▶Frequency not knownLeukaemia.musculoskeletal
stiffness.oedema
SIDE-EFFECTS, FURTHER INFORMATIONFunduscopy for
papilloedema recommended if severe or recurrent
headache, visual problems, nausea and vomiting occur—if
papilloedema confirmed consider benign intracranial
hypertension (rare cases reported).
lPREGNANCYDiscontinue if pregnancy occurs—no
information available.
lBREAST FEEDINGNo information available. Absorption
from milk unlikely.
lDIRECTIONS FOR ADMINISTRATIONRotate subcutaneous
injection sites to prevent lipoatrophy.
GENOTROPIN®, NORDITROPIN®, NUTROPINAQ®,
OMNITROPE®,SAIZEN®,ZOMACTON®For use by
subcutaneous injection.
HUMATROPE®Cartridges for use by subcutaneous
injection. Powder for reconstitution for use by
subcutaneous or intramuscular injection.
lPRESCRIBING AND DISPENSING INFORMATIONSomatropin
is a biological medicine. Biological medicines must beBNFC 2018 – 2019 Growth hormone disorders 475
Endocrine system6