Human growth hormone therapy for PWS has been proven to improve characteristic delays in physical and social development, and the cognitive benefits of human growth hormone for PWS are well documented too.
HGH dosing recommendations for people with PWS have remained broadly consistent for more than a decade and are tailored to the patient's age and other characteristics. Dr. Jennifer Miller, a pediatric endocrinologist at the University of Florida in Gainesville, outlines common dosages for children and adults and the considerations doctors use to determine dosage below.
HGH Dosing for Children With PWS
For infants and children with PWS, Dr. Miller recommends starting with 1 mg/m2 of body surface area per day. It's typical for infant dosages to be high because of their fast metabolism. Often, in the 2- to 4-year-old age range, the child's metabolism starts to decrease, so it becomes necessary to decrease the initial growth hormone dose accordingly.
Endocrinologists base their dose adjustments on different criteria: body weight, body surface area, or the patient's IGF-1 levels. Insulin-like growth factor 1, or IGF-1, is a hormone linked to the levels of growth hormone present in the body, so it's often used as an indicator to determine whether the growth hormone treatment dose is optimized.
Studies have shown that when children with growth hormone deficiencies—not specifically PWS patients—were dosed based on their IGF-1 levels, it resulted in the best growth velocity and the best height outcomes. The aim is for all children and adults to have IGF-1 levels in the upper 2/3 of their normal range.
HGH Dosing for Adults With PWS
When prescribing human growth hormone for adults with PWS, Dr. Miller typically starts between 0.2 and 0.4 mg/day. For women with PWS, it's often required to have a higher dose than men with PWS. Estrogen interferes with growth hormone metabolism, and because human growth hormone dosing for PWS is often accompanied by estrogen supplementation for bone and cardiovascular health, they will have higher prescribed doses than male patients.
Knowing When A Dose Is Right
When growth hormone is dosed too high, patients may begin to show signs of acromegaly, characterized by a bigger chin and head, and arachnodactyly (long, skinny fingers). Eventually, it can cause children to grow bigger organs, such as the heart. So monitoring growth hormone and ensuring an appropriate dose is very important.
Growth hormone is typically given at night, just before bedtime, to mimic the body’s natural pattern of growth hormone production during sleep.
Final Considerations
Endocrinologists are focused on the patient's overall health. That's why they look at the whole picture, not just hormone levels or height, and adjust accordingly. There is not a set dose for all patients; every patient is different.
The goal is to optimize growth hormone dosing so the patient can get the most benefit for a better, fuller life.
Learn more about the importance of growth hormone therapy for PWS.