Human growth hormone: What is it?

Human growth hormone: What is it?Human growth hormone is a protein that is secreted by the anterior pituitary in short pulses, mostly during the first hours of sleep and in response to stress. It is released throughout a person's lifetime and controls the production of other hormones called growth factors, throughout the body.
It particularly stimulates body growth and development in children, as well as playing an important role in child and adult metabolism, regulating the amount of muscle and fat and has effect on blood sugar levels. It also has a role in immunity and healing. Growth hormone was first isolated in 1956 and its structure was identified in 1972.

Why is it used?

Human growth hormone (HGH) therapy has been used to help growth hormone deficient children in the UK to grow normally since 1959. All supplies of HGH are now manufactured using artificial techniques called recombinant technology, but before 1985 the only source of human growth hormone was from brain tissue of human cadavers. This held an infection risk of a prion (slow virus) disease called Creutzfeldt-Jakob disease (CJD). There are other causes of CJD however, and recombinant growth hormone therapy is now the only type of growth hormone used as it is safe and cannot cause CJD.
Between 1985 and 2003, 26 cases of CJD were identified in adults who had received cadaverous human growth hormone, as children, before 1977. CJD has an incubation period of up to 30 years so most cases following the use of cadaver HGH have now been identified, although it is possible that a few more will show up. In scientific circles, it was clear as early as 1977 that there was a risk of transmission. This date has now become the determining factor in who can claim for compensation.
In 1959, severely reduced height children were given HGH to help them grow. With HGH they could reach a height close to the normal of just over 180cm. It was hailed at the time as a great medical breakthrough but was in limited supply so could only be used in the most severe cases.
HGH has found a wide range of other uses now that it can be artificially synthesised in unlimited quantities in the laboratory.
In children, it is used, in a variety of conditions where growth is restricted, not just growth hormone deficiency. For example it may be used in small for gestational age babies, Turner syndrome, Prader-Willi syndrome, and chronic renal disease.
In adults it is also used in growth hormone deficiency, which may have started in childhood, or developed later in life, causing fatigue, sleep problems, psychological upset and muscle weakness.
There may be a role for HGH in treating HIV associated muscle wasting but its use is not fully established yet.
HGH has been used illegally by athletes to build muscle bulk but research has cast doubts as to whether there is any objective improvement in performance and there are possible risks such as the development of diabetes. HGH has also been promoted by some alternative therapists as an anti-ageing treatment but again there is no scientific evidence to support its use.

What are the risks?

Elevated levels of HGH due to benign tumours of the pituitary gland lead to swelling of the soft tissues in the body; abnormal growth of the hands, feet and face; high blood pressure and an increased tendency to sweat with excessive hair growth, a condition known as acromegaly. Injections of HGH without any underlying deficiency may cause diabetes.
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Hand, foot and mouth disease

What is hand, foot and mouth disease?Many people panic when they're told they have hand, foot and mouth disease. They think they’ve got the infection that affects cattle, sheep and pigs, but the animal infection is called foot-and-mouth disease and is completely unrelated.

Causes and risk factors

Hand, foot and mouth disease is common in small children but can occur at any age. It's caused by one of several viruses, most commonly coxsackie virus A16, one of a group of viruses called enteroviruses. This is quite contagious, especially in the first week of illness, and is spread through direct contact.

Symptoms

The name of the infection comes from the fact that a rash develops on the palms of the hands and soles of the feet (and sometimes spreads further out to the legs and bottom), accompanied by sores in the mouth.
The rash takes a couple of days to appear and consists of small, flat or raised red spots, some with blisters. Similar spots in the mouth, usually on the tongue, gums and inside of the cheeks, may progress into mouth ulcers.
The child is also usually feverish, has a sore throat and feels generally unwell.

Treatment and recovery

Hand, foot and mouth disease is rarely serious. Most people need no specific medical treatment and are better within a week or so. Complications are rare, but occasionally it can lead to mild viral meningitis.
You can take simple remedies for any unpleasant symptoms, such as pain relief for the ulcers and blisters or to lower fever. Children should be given paracetamol or ibuprofen syrup. Aspirin is no longer recommended for children under 16, because of a possible link with a serious problem called Reye's syndrome.
You can also try giving them soft cold foods such as yoghurt or ice cream, and plenty of cold drinks, to ease the discomfort of a soft mouth.
Children are sometimes excluded from nursery or school during the first few days of the illness in an attempt to prevent it spreading, but this can be difficult as the viruses that cause it are widespread in the community.
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Autism and Asperger syndrome

What is autism and Asperger syndrome?To people with autism and Asperger syndrome, the world can appear chaotic with no clear boundaries, order or meaning.
These disorders can vary from very mild, where the person can function as well as anyone else around them, to so severe that they are completely unable to take part in normal society.
People with autism are usually more severely disabled, while those with Asperger syndrome tend to be more able, although this isn't always so. Because of the range of severity and symptoms, the conditions are collectively known as autistic spectrum disorders. They affect more than 580,000 people in the UK.

Symptoms of autism

The main three symptoms are:

• Difficulties with social interaction - being unaware of what's socially appropriate, finding chatting or small talk difficult and not socialising much. People with autism may appear uninterested in others and find it very difficult to develop friendships and relate to others, while those with Asperger syndrome are more likely to enjoy or want to develop social contacts, but find mixing very difficult.
• Problems with verbal and non-verbal communication – those affected may be able to speak fluently or, more commonly in autism, may be unable to speak at all. There may also be difficulties understanding gestures, body language, facial expressions and tone of voice, making it difficult to judge or understand the reactions of those they are talking to or to empathise with people's feelings. As a result, they may unintentionally appear insensitive or rude to others. They may also take others comments literally and so misunderstand jokes, metaphors or colloquialisms.
• Lack of imagination and creative play - such as not enjoying or taking part in role-play games. They may also find it difficult to grapple with abstract ideas. There may be overriding obsessions with objects, interests or routines, which tend to interfere further with building social relationships (this is known as stereotyped or repetitive behaviour).

These behavioural difficulties can cause a great deal of stress for members of the family.
A child with autism may appear unaffected as a baby and reach the usual developmental milestones, including early speech. But as they grow into toddlers, they may fail to develop normal social behaviour and speech may be lost.
As a child grows, the typical difficulties of autistic spectrum disorders are:

• Repetitive behaviour and resistance to changes in routine.
• Obsessions with particular objects or routines.
• Poor coordination.
• Difficulties with fine movement control (especially in Asperger syndrome).
• Absence of normal facial expression and body language.
• Lack of eye contact.
• Tendency to spend time alone, with very few friends.
• Lack of imaginative play.

People with Asperger syndrome are usually more mildly affected than those with autism. In fact, many people with milder symptoms are never diagnosed at all, and some argue that Asperger syndrome is simply a variation of normal rather than a medical condition or disorder. Even so, many do find that it gives them particular problems getting on in the world and they may become aware they are different from others. This can result in isolation, confusion, depression and other difficulties, all of which could be defined as 'disease'.
Some children with Asperger syndrome manage (or in fact even do very well) in mainstream schools, especially if extra support is available. However, even when children cope well academically, they may have problems socialising and are likely to suffer teasing or bullying. More severely affected children need the specialist help provided by schools for children with learning disabilities.
With the right sort of support and encouragement, many with Asperger syndrome can lead relatively normal lives. Helping them develop some insight into the condition is an important step towards adjusting to, or at least coping with, the way the rest of the world works. Some do very well, especially in an environment or job where they can use their particular talents.
Autism tends to produce more severe symptoms. For example, a child with autism may fail to develop normal speech (the development of spoken language is usually normal in Asperger syndrome) and as many as 75 per cent of people with autism have accompanying learning disabilities.
Seizures are also a common problem, affecting between 15 and 30 per cent of those with autism.
Conversely, children with autism are sometimes found to have an exceptional skill, such as an aptitude for drawing, mathematics or playing a musical instrument.

Causes of autism

The cause of autistic spectrum disorders is not yet clear. Genetics play an important role, and researchers are examining a number of chromosome sites that could be implicated. It's likely that autism occurs when a small number of genes interact in a specific way, possibly linked to some external event or factor.
This genetic link means there may be an inherited tendency, so autism and Asperger syndrome may run in families. Brothers or sisters of a child with the condition are 75 times more likely to develop it themselves.
Doctors' ability to diagnose these disorders has improved in recent years, but older people, particularly with milder problems, may never have been diagnosed. When a child is diagnosed, parents often realise they've had the same problems themselves.
Boys are more likely to be affected than girls, though research suggests that when girls have the condition they may be more severely affected.
A variety of other environmental factors that affect brain development before, during or soon after birth, also play a part (possibly acting as a trigger). Despite reports suggesting a possible link between MMR vaccination and autistic spectrum disorders, scientific evidence has confirmed the vaccination does not increase the risk.
There's no specific test for autistic spectrum disorders. Diagnosis is based on a consideration of symptoms, and milder cases may be missed.

Treatments for autism

There is no specific cure or particular medical treatment for autism, but much can be done to maximise a child’s potential and this is key to managing the condition. Appropriate specialist education, speech, language and behavioural therapy are all important. There are many different approaches (for example, the Lovaas method is an intensive behaviour therapy approach, while the Son-Rise programme is focussed on relationships).
Other interventions are based around theories about possible causes of autistic spectrum disorders – these may for example involve using foods and supplements, or medicines, which might affect the mechanical, physical and biochemical functions of the body.
While many people feel they've achieved good results with some of these interventions, none of them is a cure-all, and many lack scientific evidence to demonstrate their benefits.
Others claim dietary changes or alternative remedies have helped, but these, too, are mostly unproven.
Medication is sometimes recommended when it's felt to be of benefit to the child, for example to control seizures, depression or other symptoms.
As the precise events that lead to autistic spectrum disorders aren't yet known, it isn't possible to prevent them. Neither is there yet a simple screening test to identify people carrying genes that might increase susceptibility to autism.

Drug abuse

The use of chemicals to alter the way we feel and see things is one of the oldest activities of the human race.
But a person's use of a drug such as tobacco, alcohol, cannabis or heroin can become uncontrolled, or start to control them. Even when the use of drugs leads to serious physical and mental problems, the person using may still not want to stop.
If they do decide to give up, they may then find it's much harder than they thought.

Symptoms of drug abuse

There are a lot of bewildering different words used to describe drug use and addiction problems. Not every expert will agree with the definitions here, but being consistent about the terms used helps to reduce the confusion and anxiety everyone feels when faced with this problem.
Each drug has different patterns of:

• Use
• Intoxication
• Overdose
• Hangover

For each different drug, the term 'substance abuse' can cover different levels of use, including:

• Experimenting with use
• Bingeing
• Using large amounts without appearing intoxicated
• Using large amounts to get intoxicated

Why do people use drugs?

People can use a substance for more than one of the above reasons, and may also use several drugs, or different combinations, for different reasons.
Untangling why a person uses drug is rarely an easy task, but most people use a drug because they enjoy the effects, or feel the effects help them cope with issues in their life. This may seem like a simplistic or insensitive statement, but it's easily forgotten by the people around the drug user, who are concerned for their wellbeing.
Worried parents often ask for tell-tale signs of drug use, but the simple answer is that it's very hard to spot. Many users who have contact with mental health services manage to conceal their use from mental health professionals, so it's obviously difficult to identify.
Parents usually know their children better than anyone else, and maintaining an open atmosphere in which communication is kept up is often the best way to find out what's going on.
This is not always easy with teenagers, who are often secretive as they discover how they can control aspects of their own life and activities, as they might view the methods parents use to find out if they are using drugs as intrusive and controlling. And angry confrontations with teenagers might push them further into a cycle of resentment and refusal to communicate.

Psychological addiction to drugs

The media's portrayal of a person giving up drugs usually focuses on the immediate effects of withdrawing from heroin. It's important to remember that there's often more to an addiction than the physical withdrawal symptoms.
In fact, for some drugs such as cannabis, there's a debate about whether there are actually any physical symptoms of withdrawal. People who use cannabis regularly over a long period may find there are certain situations in which they come to rely on the drug. If they stop using it they may feel very disabled.
This is a situation that can develop for almost any substance that affects the mind and this aspect of addiction can be harder to overcome than the physical symptoms.
Mental symptoms can include:

• Anxiety
• Depression
• Disrupted sleep and rest
• Difficulty controlling mood
• Reduced wellbeing

The pattern of these symptoms will depend on the drug being used, the psychological make-up of the person using it and the circumstances under which they are attempting to remain drug free.
The term 'craving' is often used when talking about addiction. If a person is experiencing any of the symptoms listed above and they know that by using the drug all these problem will go away, it's not surprising that they develop an overwhelming desire to use and that this dominates their thoughts.

Physical addiction to drugs

It's ironic that through films such as Trainspotting quite a lot of people feel that they understand the physical effects of withdrawal from heroin. They rightly see it as an unpleasant and difficult experience - and a good reason not to experiment with it.
The irony is that alcohol has much worse and more dangerous withdrawal effects. It's possible, but very rare, for someone experiencing heroin withdrawal to need to be admitted to hospital, while someone who is physically addicted to alcohol should not attempt to stop using it without consulting a doctor.
Again, as with psychological dependence, the length and severity of withdrawal differs according to the drug, how much has been taken and for how long.
For most addicts, their problem is a mixture of both physical and psychological aspects. There are some instances when it's difficult to distinguish between the two.
The stimulants cocaine and amphetamine are classic examples of this - people coming down after using these drugs feel very low and lack energy. When they take cocaine, they feel very high and use up lots of energy. Their feelings afterwards could be partly because of feeling tired and adjusting to a normal mood again, but there are other theories that suggest these feelings are because the body is re-establishing its chemical balance.

Admitting you've a drug problem

The saying that admitting you have a problem is half of solving the problem is very applicable. The next step is to get support. You're much more likely to succeed in dealing with your drug problem if you have help and support.
If you're physically addicted, it may be dangerous just to stop - especially if you're using alcohol or tranquillizers. Even if it isn't dangerous to stop abruptly, a doctor may be able to prescribe medication to help you through the first phase of withdrawal, and may be able to offer support in areas of your life which may have driven you to use drugs in the first place.
Not all family doctors are happy to help with this problem, so if yours isn't it's probably best to approach your local drug dependence unit (DDU). It's also vital to get other forms of support and counselling - see the resources listed below.
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