Abstract
Local lipohypertrophy due to recombinant human growth hormone (rhGH) administration is a rare phenomenon. Here, we report a case of an 11-year-old girl who presented with a paraumbilical swelling, approximately one year after the start of rhGH treatment for short stature due to the presumed diagnosis of partial growth hormone insensitivity. Ultrasound imaging revealed an asymmetric distribution of subcutaneous fat tissue at the rhGH administration site, indicating local lipohypertrophy. After sparing her routine injection site and alternating other sites, the swelling disappeared within 6 months. Although the precise cause of local lipohypertrophy resulting from rhGH administration is still unclear, it might be related to the presumed diagnosis of partial growth hormone insensitivity.
Highlights
Human growth hormone is usually administered via subcutaneous injections
Because repeated serum Insulin-like growth factor 1 recombinant human growth hormone (rhGH) (IGF-1) measurement revealed concentrations below −2 SD for age, an IGF-1 generation test was performed (Table 1). She was treated with rhGH under the suspicion of partial GH resistance
Nowadays, approved indications for rhGH treatment include growth hormone deficiency, short stature due to Turner syndrome, incomplete catch-up growth in children who were small for gestational age, growth failure associated with chronic renal failure, Prader-Willi syndrome and, more recently, idiopathic short stature, and AIDS-related wasting and fat accumulation associated with lipodystrophy [1]
Summary
Human growth hormone (hGH) is usually administered via subcutaneous injections. Besides well-known adverse events such as peripheral edema, benign intracranial hypertension, and slipped capital femoral epiphysis, a less known and rare side effect is local lipohypertrophy, a phenomenon with an incompletely understood pathophysiology. When the girl was 2.5 years old, her growth curve had declined (Figure 1) Her height standard deviation (SD) score had decreased from −2.0 at the age of one year to −3.0 at the age of 2.5 years. Diseases, and systemic/inflammatory diseases), around the age of 3 years GH stimulation testing (arginine and L-dope and propranolol) showed a maximum GH concentration of 59.0 mE/L, ruling out classical growth hormone deficiency. Because repeated serum IGF-1 measurement revealed concentrations below −2 SD for age, an IGF-1 generation test was performed (Table 1) After these investigations, she was treated with rhGH (daily subcutaneous injections) under the suspicion of partial GH resistance. Ultrasound imaging of the swelling was performed, which revealed an asymmetric distribution of subcutaneous fat on the injection site, with a thickness difference of 6 mm (left more than right). After 6 months, the swelling had decreased and the pain had disappeared and she had reported no (other) adverse effects
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