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What to expect at the specialist.

Short stature is a common reason for a child to see a specialist, such as a pediatric endocrinologist. But remember, only a small number of children actually have growth disorders. If you and your doctor have decided to take the next step and have a pediatric endocrinologist examine your child, you can move toward identifying and addressing the issue, if one indeed exists.

The evaluation.

Diagnosing the cause behind your child’s growth problem is accomplished through an evaluation and some diagnostic tests. Every child is different, so the pediatric endocrinologist will choose an evaluation that best suits your child. They may ask for any or all of the following information:

Medical history


Mother’s nutrition and use of alcohol, nicotine, or other drugs during pregnancy


Birth length and weight compared to gestational age


Prior medical records from your child’s primary care physician, including past growth measurements, illnesses, surgeries, or hospitalizations


Emotional development


Eating and playing habits


School performance


Participation in social events


Emotional or physical traumas


Family history


Information on birth parents


When birth parents went through puberty


Diseases (such as celiac disease) that run in the parents’ families


Physical Examination

A complete physical exam will include measuring height and weight. Other measurements may include:


Head circumference – the length around your child’s head


Arm span – the length from the tip of one hand to the other with outstretched arms


The ratio between upper and lower body measurements


Sitting height


Body composition (percent of lean muscle and fat)

Evaluation of growth.

Using a growth chart, the doctor or nurse will compare your child’s height and weight with the statistical norm. This is the average height and weight of children who are the same age and sex.

Diagnostic tests.

Lab tests

Blood tests may be ordered to evaluate your child’s general health, and to rule out medical conditions such as celiac disease, cystic fibrosis, and Crohn’s disease as the cause of your child’s growth issue.

The stimulation (“stim”) test

Some doctors use stimulation testing to check for growth hormone deficiency in children and adults. Because the pituitary gland releases different amounts of growth hormone throughout the day, a single test won’t accurately measure the amount of growth hormone in the blood. A stim test can tell us whether the pituitary gland releases the appropriate amount of growth hormone in response to stimulation.

Radiology evaluation

The doctor may perform tests that see inside the body, such as:


X–rays


Magnetic resonance imaging (MRI) test


Computed tomography (CT) scans


A bone age X–ray


The bone age X–ray is an important test to tell the doctor whether your child’s bones are developing at the right rate for his or her age. It can also show if your child still has room for growth.

If a diagnosis is made.

If your pediatric endocrinologist determines that your child has a growth disorder, you will probably have lots of questions. Here are a few you may want to ask:


What has my child been diagnosed with?


How long will my child have this condition?


What will the impact of this condition be on my child’s life?


What can I do as a parent to help manage my child’s condition?


Will my child need treatment and what will the treatment involve?


After your child is diagnosed, you’ll be presented with your options, which may include growth hormone therapy. Your pediatric endocrinologist and your health care team will assist you in developing a care plan that is best suited to your child.

Questions for the specialist.

Receiving a diagnosis of growth hormone disorder isn’t easy, but for many children, it’s also the first step to treatment. When weighing the pros and cons of taking that step, it’s helpful to have as much information as possible. Here are some treatment-related questions you may want to ask the pediatric endocrinologist:


If we were to start my child on growth hormone, when will we start to see growth?


How much growth should we expect to see?


How long would my child remain on treatment?


Does my child have any risk factors?


Are there side effects we should be aware of?


Are there any safety concerns I should know about before using growth hormone treatment?



What are the differences between the available therapies?


What should we know about storing, handling, and traveling with treatment?


Are there pros and cons of the various delivery devices?


If we start treatment, would there be patient services available?


What about financial assistance?


What can you tell me about insurance coverage?


Growth Track Wizard™

Once your child is diagnosed, you may want to track their growth, using our Growth Track Wizard. This handy tool will display an easy-to-read Summary Report after you enter a few measurements.

Norditropin® Stories.

Learn more about Josh, age 13, who is being treated with Norditropin®.

What growth hormone does.

Growth hormone plays an important role in the body. Learn more about how it works, telling bones, muscles, and other tissues to grow.

Selected Important Safety Information

Do not use Norditropin® if: you have a critical illness caused by certain types of heart or stomach surgery, trauma or breathing (respiratory) problems; you are a child with Prader-Willi syndrome who is severely obese or has breathing problems including sleep apnea; you have cancer or other tumors; you are allergic to somatropin or any of the ingredients in Norditropin®; your healthcare provider tells you that you have certain types of eye problems caused by diabetes (diabetic retinopathy); you are a child with closed bone growth plates (epiphyses).

Indications and Usage

What is Norditropin® (somatropin) injection?
 
Norditropin® is a prescription medicine that contains human growth hormone and is used to treat:
  • children who are not growing because of low or no growth hormone 
  • children who are short (in stature) and who have Noonan syndrome, Turner syndrome, or were born small (small for gestational age-SGA) and have not caught-up in growth by age 2 to 4 years 
  • children who have Idiopathic Short Stature (ISS) 
  • children who are not growing who have Prader-Willi syndrome (PWS) 
  • adults who do not make enough growth hormone

Important Safety Information (cont’d)

Before taking Norditropin®, tell your healthcare provider about all of your medical conditions, including if you:

  • have had heart or stomach surgery, trauma or serious breathing (respiratory problems) 
  • have had a history of problems breathing while you sleep (sleep apnea) 
  • have or have had cancer or any tumor 
  • have diabetes 
  • are pregnant or breastfeeding, or plan to become pregnant or breastfeed

Tell your healthcare provider about all the medicines you take, including prescription and over-the-counter medicines, vitamins, and herbal supplements. Norditropin® may affect how other medicines work, and other medicines may affect how Norditropin® works.

How should I use Norditropin®?

  • Use Norditropin® exactly as your health care provider tells you to 
  • Do not share your Norditropin® pens and needles with another person even if the needle has been changed. You may give another person an infection or get an infection from them.

What are the possible side effects of Norditropin®?
Norditropin® may cause serious side effects, including:

  • high risk of death in people who have critical illnesses because of heart or stomach surgery, trauma or serious breathing (respiratory) problems 
  • high risk of sudden death in children with Prader-Willi syndrome who are severely obese or have breathing problems including sleep apnea 
  • increased risk of growth of cancer or a tumor that is already present and increased risk of the return of cancer or a tumor in people who were treated with radiation to the brain or head as children and who developed low growth hormone problems. Contact the healthcare provider if you or your child start to have headaches, or have changes in behavior, changes in vision, or changes in moles, birthmarks, or the color of your skin 
  • new or worsening high blood sugar (hyperglycemia) or diabetes 
  • increase in pressure in the skull (intracranial hypertension). If you or your child has headaches, eye problems, nausea or vomiting, contact the healthcare provider 
  • serious allergic reactions. Get medical help right away if you or your child has the following symptoms: swelling of your face, lips, mouth or tongue, trouble breathing, wheezing, severe itching, skin rashes, redness or swelling, dizziness or fainting, fast heartbeat or pounding in your chest, or sweating 
  • your body holding too much fluid (fluid retention) such as swelling in the hands and feet, pain in your joints or muscles or nerve problems that cause pain, burning, or tingling in the hands, arms, legs and feet. Tell your healthcare provider if you have any of these signs or symptoms of fluid retention. 
  • decrease in a hormone called cortisol. Tell your or your child’s healthcare provider if you or your child has darkening of the skin, severe fatigue, dizziness, weakness or weight loss 
  • decrease in thyroid hormone levels 
  • hip and knee pain or a limp in children (slipped capital femoral epiphysis) 
  • worsening of pre-existing curvature of the spine (scoliosis) 
  • severe and constant abdominal pain can be a sign of pancreatitis. Tell your or your child’s healthcare provider if you or your child has any new abdominal pain. 
  • loss of fat and tissue weakness in the area of skin you inject 
  • increase in phosphorus, alkaline phosphatase, and parathyroid hormone levels in your blood

The most common side effects of Norditropin® include:

  • injection site reactions and rashes, and headaches

Please click here for Norditropin® Prescribing Information.

Norditropin® is a prescription medication.

Novo Nordisk provides patient assistance for those who qualify. Please call 1-866-310-7549 to learn more about Novo Nordisk assistance programs.

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.

Talk to your health care provider and find out if Norditropin® is right for you or your child.