Category: General

In boys, puberty generally starts between ages 10 to 14. However, it could start any time after nine years of age. The first sign of puberty in boys is the enlargement of the testes. However, this is rarely noticeable from the outside. Later, the pubic hair starts to appear. Further developments lead to an enlarged penis, voice changes and an increase in height. Most boys would complete the pubertal growth by 18 years of age.

If you notice any signs of puberty below nine years in a boy, it merits a visit to an endocrinologist. The investigations are directed at the causes of increased androgen (male hormone) production. Increased androgen production could be from the testes (directly or triggered by the pituitary) or the adrenal glands. For boys, it is essential to investigate the cause of puberty. It could be an activation of the brain’s hypothalamus that controls the pubertal process. It can be caused by tumours, cysts, hamartomas, infections, or congenital causes. It could be due to disorders of the testes or adrenals. Since some of these causes may be potentially dangerous, it is essential to diagnose them early.

Dr. Mathew John MD,DM

The onset of puberty below eight years in girls and below nine years in boys is called precocious puberty. The endocrinologist should see all kids with suspected precocious puberty. Some of them are normal puberty that started earlier than expected. On the other hand, some kids with early puberty may turn out to have diseases of the pituitary, the hypothalamus, the gonads (testes and ovaries) or even the adrenals. The early onset of puberty will bring both emotional and physical problems. The biological concern includes early stoppage of bone growth leading to short adult height. In addition, kids with early puberty are highly self-conscious about the changes occurring in their bodies. This may lead to low self-esteem and increase the risk of depression and substance abuse. The early onset of menstrual periods in girls is also a concern to parents. Medicines called GnRH analogues (e.g. Leuprolide, Triptorelin) are commonly used to stop the production of gonadotropins and, hence, arrest puberty’s progression. When used early and at an appropriate age, these drugs help to improve the final HEIGHT of kids with precocious puberty. They are generally safe and have very few adverse effects.

Dr. Tittu Oommen MD,DM

The typical age for puberty onset in girls is around 11. The first sign of puberty in girls is breast enlargement, which is called thelarche. Pubic and underarm hair grows, and body hair may darken. The height spurt in girls starts almost at a time when there is growth of the breast, and the velocity comes down as they get their menstruation. Most girls attain their adult height by the time they reach the age of 15 years.  

In boys, puberty usually starts between the ages of 10 and 14, with the average age being 12. The first sign of puberty in boys is an enlargement of the testes, which often goes unnoticed. They then develop pubic hair and growth of the penis. The growth spurt happens in mid-puberty, and they soon have a deepening of voice. The axillary hair and facial hair appear around this time. Most boys reach their final height around 16-18 years.

 Dr Mathew John MD, DM

Checking a single growth hormone (GH) level is not sufficient to diagnose growth hormone deficiency because GH is released in sporadic bursts, primarily overnight, making a single blood test unreliable. The size and duration of these pulses vary with the time of day, age, and sex, rendering random GH measurements rarely useful. A higher level may appear normal if the blood was drawn during a pulse, while a lower level may be normal if the blood was drawn at the end of a pulse. Instead, endocrinologists use the following tests to diagnose growth hormone deficiency:

 1)Growth Hormone Stimulation Test:

This is the primary test for diagnosing growth hormone deficiency. During the test, your child will receive medications designed to stimulate the pituitary gland to release GH. Blood samples are then taken at intervals to measure GH levels and sent to the lab for testing. If the results show that GH levels did not rise to the expected level, it may indicate that the pituitary gland is not producing enough GH.

2)IGF-1 Blood Test:

 Other blood tests measure substances like insulin-like Growth Factor 1 (IGF-1), which is produced when GH stimulates the liver. IGF-1 then promotes growth in bones, muscles, and organs. Because IGF-1 remains in the bloodstream longer than GH, doctors can use IGF-1 levels as an indirect measure of GH levels.

It is also essential to understand that in certain diseases like Turner syndrome, Prader Willi Syndrome, and in kids who are born small for gestational age, growth hormone testing is not necessary before starting growth hormone.

Together, these tests provide a more accurate diagnosis of growth hormone deficiency, ensuring appropriate treatment for the affected individuals.

Dr. Tittu Oommen MD, DM

Some adults have growth hormone deficiency due to diseases of the pituitary. This may be due to radiation or surgery. These people have low muscle mass, fatigue and depressed mood. They benefit from taking growth hormone replacement.
However, GH is commonly used as a gym supplement and in competitive sports. GH is banned by the International Olympic Committee. It is punishable if a person is found to be using GH while engaging in competitive sports events at the national or international level. Scientific studies have shown that using GH in normal people who engage in sports improves muscle mass. However, this has not been translated into strength, exercise capacity or performance. Further, people using large doses of GH experience diabetes, hypertension, arthralgia and fluid retention.
Hence, it is high time to restrict the availability of GH for recreational use in sports and gyms.

Dr. Mathew John MD, DM

Growth hormone therapy can be initiated at any age before a child’s growth plates fuse, which is typically around 14 years for girls and 16 years for boys. It’s common for parents to seek medical advice when their child in primary school or approaching puberty appears significantly shorter than their peers or is growing more slowly than expected. Even infants born with growth hormone deficiency can benefit from this therapy. This deficiency might result from abnormal pituitary gland development, causing a lack of growth hormone and potentially other hormones as well. Recognizing that growth hormone deficiency can manifest at any age is important.

Early diagnosis and intervention are crucial for children with growth hormone deficiency to ensure they achieve their full growth potential. The timing of growth hormone therapy significantly impacts a child’s height outcome, with the best results observed when treatment is started between the ages of 2 to 9 years. This is because early initiation helps catch up on the growth deficit before puberty begins. Once puberty starts, the effectiveness of growth hormone therapy diminishes considerably due to the natural fusion of growth plates, which limits further growth in height.

In conclusion, while growth hormone therapy can be highly beneficial, its success largely depends on timely diagnosis and appropriate management. Parents and caregivers should be vigilant about their child’s growth patterns and seek medical advice if there are concerns about short stature or slow growth, ensuring that any potential growth hormone deficiency is addressed promptly and effectively.

Dr. Tittu Oommen MD, DM

Kids are given growth hormone to treat growth hormone deficiency. Some parents doubt whether their kids may grow too tall by taking growth hormone. However, this does not happen.

The kid’s growth stops when the growth plate fuses. When patients are started on GH, the growth plate matures and they increase in height. Ultimately, the growth plate closes, and the person reaches the final height. This height is in keeping with the individual’s genetic potential. So, kids won’t grow too tall if they receive growth hormone.

Dr. Mathew John MD, DM

No. Most people reach adult height by 18 years; girls reach by 14-15 years, and boys by 16-18 years. A person gains height when their bones grow progressively. The bones grow at a growth plate (epiphyseal cartilage). However, due to the effect of male and female hormones, the cartilage plate reduces in width and ultimately fuses, preventing any further growth. The status of the growth plate can be checked in X-rays.

So, in adults, there is no more growth plate to promote growth. So, normal adults cannot grow taller even if they take growth hormone. However, the growth plate remains open for a long time in diseases like growth hormone deficiency. Hence, growth may continue beyond 18 years. However, this growth is promoted only when treated with growth hormone.

So don’t fall for therapies advertised to promote height in adults. Despite the best efforts, it will not happen.

Dr. Mathew John MD, DM

Growth hormone (GH) is naturally produced and secreted from our pituitary gland. GH is essential to stimulate normal growth, muscle and bone strength, and fat distribution. In some instances, growth hormone secretion gets compromised and may result in Growth Hormone Deficiency (GHD). Although not common, GHD can occur at any age. Still, it is usually identified among infants and children, and children may grow shorter than their expected standard height.
The causes of growth hormone deficiency are varied. Most are congenital, but some may be acquired due to diseases of the pituitary gland like surgery, trauma or radiation. Congenital causes of GHD occur from birth due to genetic mutations.

The common symptoms are

• Slow growth

• Younger looking round face

• Absent or delayed pubertal changes

• Short stature

• Reduced bone strength

Usually, GH treatment is given for the following conditions.

• Growth Hormone deficiency ( acquired, congenital or idiopathic)

• Prader-Willi Syndrome

• Turner’s Syndrome

• Idiopathic short stature ( cause is unknown).

• Small for gestational-age children who do not have adequate catch-up growth

• Noonan’s syndrome

• SHOX gene haploinsufficiency

• Chronic Renal Insufficiency with poor growth.

Adults can also develop GHD, which can affect their structure and metabolism. These are due to trauma, pituitary surgeries or radiation.

Dr. Deepa G, MHSc (Diab), Dip (Diab)

People living with diabetes often fear diabetes complications. Of course, uncontrolled blood sugars are the reason for diabetes-related health issues and complications. People with diabetes may experience a fear of hypoglycemia (low blood sugars) and hyperglycemia (uncontrolled blood sugars) and are prone to long-term complications that may affect the heart, kidneys, eyes, legs, and brain. Such fear may affect self-management skills and impair the quality of life and emotional well-being.

Why do people fear diabetes complications?

• Inadequate knowledge about diabetes and its complications

• Lack of social support, i.e., from friends, colleagues, and partners.

• Previous episodes of low blood glucose

• Limited understanding of hypoglycemia management and sick day management.

These situations can be overcome through proper diabetes education by a certified diabetes educator, psycho-educational interventions, and regular consultation with a treating consultant.

How can I overcome these fears?

1. Control blood glucose/sugar levels: glucose control has been found to reduce all the complications of diabetes. So, intensive blood glucose control with diet, medicines, self-monitoring and Continuous Glucose Monitoring (CGM) devices helps maintain glucose levels.

2. Maintain target blood pressure & LDL levels to avoid risks of heart attacks and stroke.

3. Practice preventive foot care with an annual neuropathy and blood vessel disease evaluation.

4. Annual dilated eye examinations for diabetic retinopathy

5. Modifying lifestyle: Sugars should be cut out of the equation altogether, and fibre intake, adequate protein, and low-glycemic carbohydrates should be increased. Other lifestyle changes that include stopping tobacco and alcohol and regular physical activities should be done as well.

6. We are using appropriate medicines and preventive measures to avoid complications.

It is good to understand diabetes and its complications and prevention methods. Knowledge helps; fear does not!

Ms. Revathy V.K, MSc