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Early onset of growth hormone deficiency in childhood
In patients with early onset of growth hormone deficiency in childhood, the ability to secrete growth hormone should be examined at the end of the growth phase.

This review is not necessary in patients with more than three pituitary hormone deficiencies, in patients with severe growth hormone deficiency due to a defined genetic cause, due to structural hypothalamic-pituitary abnormalities, Central nervous system or high-dose cerebral radiation therapy, or due to growth hormone deficiency following pituitary or hypothalamic disease, or pituitary or hypothalamic involvement, if the measurement of IGF-I (Insulin-like Growth Factor-I) is less than -2 SDS after a break of at least 4 weeks of growth hormone therapy.

Beginning of adult growth hormone deficiency
In adults, insulin tolerance testing is the most common diagnostic test. However, compared to the insulin tolerance test, these tests are less convincing for diagnosis.

Recommended Doses
children
Deficiency of growth hormone
Dose of 0.025-0.035 mg / kg of body weight per day or 0.7-1.0 mg / m² of body surface area per day

Children with intrauterine growth retardation (GAS)
Dose of 0.033-0.067 mg / kg of body weight per day or 1.0-2.0 mg / m² of body surface area per day.Buy norditropin online | norditropin for sale | norditropin

In the event of severe growth hormone deficiency (response <6 ng / ml following a stimulation test), further treatment according to the literature may be considered up to about 25 years of age.

Prader-Willi Syndrome
Dose of 0.025-0.035 mg / kg of body weight per day or 0.7-1.0 mg / m² of body surface area per day.

The recommended dose is usually 0.035 mg / kg body weight per day until reaching the final size.

Subcutaneous injection is the recommended route of administration. Some studies have shown that a replacement of the im injection with sc injection leads to an acceleration of growth in one year. Moreover, an im injection causes a high, supraphysiological, but brief serum growth hormone level. The sc injection makes it possible to achieve more regular serum concentrations, better suited to the physiological values. During injection sc, the injection site must be changed between each injection, in order to avoid the appearance of lipoatrophy.

Duration of treatment: The duration of the treatment usually carried out continuously for several years depends on the evolution of the body size and the intended therapeutic objective.Buy norditropin online | norditropin for sale | norditropin

adults
Growth Hormone Deficiency
Women may require a higher dose than men, as men have an increased sensitivity to IGF-I over time. This means that there is a low risk of administration to women, especially when they are receiving oral estrogen replacement therapy, while men are receiving a dose that is too high.Buy norditropin online | norditropin for sale | norditropin

The necessary dose decreases with age. The maintenance dose varies considerably from one person to another, but should rarely exceed 1.0 mg / day (3 IU / day). The duration of treatment in adults is not determined. A specialist should check, at intervals of one year, whether the treatment brings the expected clinical benefit and therefore whether further treatment is useful. The dosage should be monitored on the basis of IGF-I measurements.

There is no experience with dosages above 1 mg / day.Buy norditropin online | norditropin for sale | norditropin

Cons-indications
Severely ill patients with acute respiratory failure or complications following major abdominal or cardiac surgery or as a result of polytrauma.
Children with trisomy 21 or Bloom syndrome.
In children with Fanconi anemia.
Patients with Prader-Willi syndrome suffering from severe obesity or respiratory failure.
Patients with proliferative or pre-proliferative diabetic retinopathy.
In children with chronic renal failure, treatment with Norditropin should be completed in a renal transplant.
Pregnancy, breastfeeding.
Hypersensitivity to the active principle or to one of the excipients according to the composition.
Warnings and Precaution
The maximum recommended daily dose (see “ Dosage / Directions for Use”) should not be exceeded.

Growth Hormone Deficiency in Adults
Adult growth hormone deficiency is a lifelong disease that needs to be treated accordingly. However, to date, there are few experiments on the treatment of patients over 60 years of age who have been receiving growth hormone over a period of more than 5 years.

Chronic renal failure
Renal function usually worsens in patients with chronic renal failure.

Long-term effect
There are no long-term data for Norditropin in both Turner’s syndrome and chronic renal failure, and treatment should be under strict medical supervision.

Endocrine Disorders
A sliding of the upper femoral epiphysis on its metaphysis (Epiphyseolysis capitis femoris) may occur more frequently in patients with endocrine disorders, and Legg-Perthes-Calvé disease may occur more frequently in patients of small size. This can result in lameness, hip or knee pain. The physician as well as the parents must remain alert to the onset of these symptoms.Buy norditropin online | norditropin for sale | norditropin

Antibody
As with all drugs that contain somatropin, a small percentage of patients may develop antibodies to somatropin. The binding capacity of these antibodies is low and has no effect on growth rate.

Side effects
Especially in adults, fluid retention accompanied by peripheral edema may occur. Carpal tunnel syndrome is rare, but may occur in adults. Symptoms are usually transient, dose-dependent, and may require a dose reduction.Buy norditropin online | norditropin for sale | norditropin

Slight joint pain, muscle pain and paresthesia may occur.

Blood and lymphatic system disorders
Very rare: Leukemia in children with a small pituitary size. The incidence appears to be comparable to that in children without growth hormone deficiency.Buy norditropin online | norditropin for sale | norditropin

Immune system disorders
Rare: Anaphylactic reactions

Endocrine Disorders
Rare: Increased blood glucose, type II diabetes mellitus, hypothyroidism.

Very rare: Gynecomastia. Buy norditropin online | norditropin for sale | norditropin

Nervous System Disorders
Common: Headache and paresthesia.

Occasional: Carpal tunnel syndrome.

Very rare: Benign intracranial hypertension.Buy norditropin online | norditropin for sale | norditropin

Skin and subcutaneous tissue disorders
Occasional: Pruritus.

Musculoskeletal and Connective Tissue Disorders
Frequent: Joint stiffness, arthralgia, myalgia.

Casual: Muscle stiffness.

General disorders and administration site conditions
Very common: Peripheral edema.

Common: Generalized edema.

Occasional: Injection site pain.Buy norditropin online | norditropin for sale | norditropin

Pediatric population
In children, the adverse effects observed were the same as in adults, but in some cases, with a different frequency, as indicated below:

Nervous System Disorders
Occasional: headache.

Skin and subcutaneous tissue disorders
Rare: rash.

Musculoskeletal and Connective Tissue Disorders
Very rare: arthralgia, myalgia.

General disorders and administration site conditions
Occasional: pain and other reactions at the injection site.

Very rare: increased sweating, peripheral edema.

Overdose
Short-term overdose may initially lead to hypoglycaemic reactions, followed by hyperglycaemia. Long-term overdose may cause symptoms of acromegaly.

Action mechanism
Norditropin is a human growth hormone produced by genetic engineering (somatropinum humanum), identical to the hormone extracted from the human pituitary composed of a peptide chain of 191 amino acids. Pharmacological and clinical-experimental studies have confirmed that Norditropine exerts the same therapeutic effects as growth hormone extracted from the pituitary gland.

Growth hormone (GH), also known as somatotropin (or as human growth hormone [hGH or HGH] in its human form), is a peptide hormone that stimulates growth, cell reproduction, and cell regeneration in humans and other animals. It is thus important in human development. It is a type of mitogen which is specific only to certain kinds of cells.

Structure
The major isoform of the human growth hormone is a protein of 191 amino acids and a molecular weight of 22,124 daltons. The structure includes four helices necessary for functional interaction with the GH receptor. It appears that, in structure, GH is evolutionarily homologous to prolactin and chorionic somatomammotropin. Despite marked structural similarities between growth hormone from different species, only human and Old World monkey growth hormones have significant effects on the human growth hormone receptor.

Regulation
Secretion of growth hormone (GH) in the pituitary is regulated by the neurosecretory nuclei of the hypothalamus. These cells release the peptides Growth hormone-releasing hormone (GHRH or somatocrinin) and Growth hormone-inhibiting hormone (GHIH or somatostatin) into the hypophyseal portal venous blood surrounding the pituitary.

Somatotropic cells in the anterior pituitary gland then synthesize and secrete GH in a pulsatile manner, in response to these stimuli by the hypothalamus. The largest and most predictable of these GH peaks occurs about an hour after onset of sleep with plasma levels of 13 to 72 ng/mL.Otherwise there is wide variation between days and individuals. Nearly fifty percent of GH secretion occurs during the third and fourth NREM sleep stages.Surges of secretion during the day occur at 3- to 5-hour intervals.The plasma concentration of GH during these peaks may range from 5 to even 45 ng/mL. Between the peaks, basal GH levels are low, usually less than 5 ng/mL for most of the day and night.

Properties / Effects
ATC code: H01AC01

Action mechanism
Pharmacological and clinical-experimental studies have confirmed that Norditropine exerts the same therapeutic effects as growth hormone extracted from the pituitary gland. Norditropin is injected sc, whereas im administration is no longer considered adequate.

Pharmacodynamics
The main effect of growth hormone is the stimulation of bone and body growth, and a clear influence of metabolic processes in the body.

Somatropin exerts most of its effects indirectly via IGF-I.

Clinical Efficacy
adults
In adults, clinical trial results (a total of 303 patients in 7 placebo-controlled studies with various measured parameters) varied and were mostly not clinically significant. The following parameters have been influenced by the following factors:

Central obesity: is slightly decreased.

Grease-free mass: slightly increased.

Total fat mass: is not changed.

Bone Density (BMD): after a slight initial degradation, an increase usually occurs after 1 to 2 years. There are no data on fractures.

Plasma lipids: decrease in total cholesterol and LDL, increase in HDL.

Muscular strength and cardiovascular performance: no influence.

Subjective quality of life: variable influence not significant.

Mortality (total and cardiovascular): no data available.

Excess
The most common disease of GH excess is a pituitary tumor composed of somatotroph cells of the anterior pituitary. These somatotroph adenomas are benign and grow slowly, gradually producing more and more GH. For years, the principal clinical problems are those of GH excess. Eventually, the adenoma may become large enough to cause headaches, impair vision by pressure on the optic nerves, or cause deficiency of other pituitary hormones by displacement.

Prolonged GH excess thickens the bones of the jaw, fingers and toes.Accompanying problems can include sweating, pressure on nerves (e.g., carpal tunnel syndrome), muscle weakness, excess sex hormone-binding globulin (SHBG), insulin resistance or even a rare form of type 2 diabetes, and reduced sexual function.

It is extremely rare for such a tumor to occur in childhood, but, when it does, the excessive GH can cause excessive growth, traditionally referred to as pituitary gigantism.

Surgical removal is the usual treatment for GH-producing tumors.

Deficiency
Main article: Growth hormone deficiency
The effects of growth hormone deficiency vary depending on the age at which they occur.

Adults with GHD also”tend to have a relative increase in fat mass and a relative decrease in muscle mass and, in many instances, decreased energy and quality of life”.

Diagnosis of GH deficiency involves a multiple-step diagnostic process, usually culminating in GH stimulation tests to see if the patient’s pituitary gland will release a pulse of GH when provoked by various stimuli.