Growth Hormone Disorders in Children: An Overlooked Issue in India

In India, where the health of children is a priority for families and communities, growth hormone disorders remain a largely overlooked issue. These disorders, which affect a child’s physical development, can have profound impacts on their overall well-being, yet awareness and timely intervention are often lacking. This blog explores the nature of growth hormone disorders, their prevalence in India, challenges in diagnosis and treatment, and the way forward to address this critical health concern.

Understanding Growth Hormone Disorders

Growth hormone (GH) disorders occur when the pituitary gland, a small gland at the base of the brain, produces too little or too much growth hormone. This hormone is crucial for a child’s growth, regulating height, bone development, and overall physical maturation. The two primary types of GH disorders in children are:

Growth Hormone Deficiency (GHD): This condition occurs when the body does not produce enough growth hormone, leading to short stature, delayed puberty, and sometimes other health issues like low energy or weak bones.
Excess Growth Hormone (Gigantism): Though rare, this occurs when the pituitary gland produces excessive growth hormone, causing abnormal height and rapid growth.

In India, GHD is more common than gigantism, with estimates suggesting it affects 1 in 3,800 to 1 in 10,000 children globally. While precise data for India is scarce, the condition is likely underdiagnosed due to limited awareness and access to healthcare.

Why Is This an Overlooked Issue in India?

Several factors contribute to growth hormone disorders being underrecognized in India:

Lack of Awareness: Many parents and even healthcare providers may mistake slow growth for normal variation or poor nutrition. In a country where malnutrition is prevalent, stunted growth is often attributed to dietary deficiencies rather than hormonal issues.
Limited Access to Pediatric Endocrinologists: India has a shortage of specialists trained in pediatric endocrinology. Most specialists are concentrated in urban areas, leaving rural families with limited access to proper diagnosis and care.
High Cost of Diagnosis and Treatment: Diagnosing GHD requires specialized tests like the growth hormone stimulation test, which can be expensive. Treatment with recombinant human growth hormone (rhGH) injections is also costly, often ranging from ₹50,000 to ₹1,50,000 per month, making it unaffordable for many Indian families.
Cultural Perceptions: In some communities, short stature is not seen as a medical issue but rather as a natural trait or something to be accepted. This mindset delays seeking medical help, especially in rural and semi-urban areas.
Focus on Other Health Priorities: With infectious diseases, malnutrition, and sanitation challenges dominating India’s public health agenda, endocrine disorders like GHD receive less attention from policymakers and healthcare systems.

The Impact of Untreated Growth Hormone Disorders

The consequences of untreated GH disorders go beyond physical appearance. Children with GHD may face:

Physical Health Issues: Weak bones, increased risk of fractures, and delayed puberty can affect long-term health.
Psychosocial Challenges: Short stature can lead to low self-esteem, bullying, and social isolation, particularly in a society where physical appearance often influences social interactions.
Academic and Career Impacts: Delayed development can affect cognitive growth and confidence, potentially limiting academic performance and future opportunities.

For children with gigantism, untreated conditions can lead to complications like joint pain, heart problems, and reduced life expectancy. Early intervention is critical to mitigate these risks.

Challenges in Diagnosis and Treatment

Diagnosing growth hormone disorders in India is fraught with challenges:

Delayed Diagnosis: Parents often seek medical advice only when growth issues become pronounced, sometimes after the critical growth years (before puberty), reducing the effectiveness of treatment.
Inadequate Screening: Routine growth monitoring is not a standard practice in many Indian schools or primary healthcare centers, unlike in some Western countries.
Treatment Barriers: Even when diagnosed, the high cost of rhGH therapy and the need for daily injections for years deter many families. Additionally, there are concerns about the availability of quality medications and the risk of counterfeit drugs in some markets.

The Way Forward: Addressing Growth Hormone Disorders in India

To tackle this overlooked issue, a multi-pronged approach is needed:

Raising Awareness: Public health campaigns can educate parents, teachers, and healthcare providers about the signs of growth hormone disorders. Simple indicators like a child consistently falling below the 3rd percentile on growth charts should prompt further investigation.
Strengthening Healthcare Infrastructure: Training more pediatric endocrinologists and equipping primary healthcare centers with basic growth monitoring tools can improve early detection. Telemedicine can bridge the gap for rural families, connecting them with specialists in urban centers.
Subsidized Treatment: Government and private sector partnerships can help subsidize diagnostic tests and rhGH therapy. Programs like the Rashtriya Bal Swasthya Karyakram (RBSK) could include growth hormone disorders in their screening and treatment protocols.
School-Based Growth Monitoring: Implementing mandatory growth tracking in schools, as done in countries like Japan, can help identify children with growth issues early. This could be integrated into existing mid-day meal programs or health check-ups.
Research and Data Collection: India needs more data on the prevalence of GH disorders to inform policy. Research into cost-effective diagnostic tools and treatments tailored to the Indian context is also essential.
Community Support: Support groups for parents and children with GH disorders can provide emotional and practical guidance, reducing stigma and encouraging treatment adherence.

A Call to Action

Growth hormone disorders in children are not just a medical issue but a societal one, affecting a child’s confidence, opportunities, and quality of life. In a country as diverse and populous as India, addressing this issue requires collective effort from healthcare providers, policymakers, educators, and communities. By raising awareness, improving access to care, and prioritizing early intervention, we can ensure that no child’s potential is stunted by an overlooked hormonal disorder.

Let’s take the first step by talking about growth hormone disorders and advocating for every child’s right to grow healthy and strong.

𝗗𝗿. 𝗦𝗵𝘆𝗮𝗺 𝗦𝘂𝗻𝗱𝗮𝗿 𝗖 𝗠
Consultant Endocrinologist
Grapes Diabetes & Endocrine Clinic
1491, first floor, Grapes Clinic, SV Arcade, BEML Layout, 5th Stage, Rajarajeshwari Nagar, Bengaluru, Karnataka 560098

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