Counselling a family starting recombinant growth hormone therapy — OSCE

A strong candidate frames the conversation around three questions the parents are really asking — what is wrong, what will we do, and what will happen — and addresses the practical and emotional burden of a daily injection honestly. The diagnosis is explained in plain language: the gland that produces the growth hormone signal is underactive, so the signal is too weak and the bones are not growing at the normal rate; the delayed bone age is good news because it means there is time to catch up. The therapy is a daily subcutaneous injection of recombinant growth hormone given at bedtime to mimic the body's natural overnight pulse, at a starting dose of around 0.045 to 0.050 mg/kg/day, with the dose adjusted to keep a blood test (the IGF-1) in the right range. [1] [2]

The safety discussion must be honest and balanced. The common side effects are minor and reversible — local injection-site reactions, occasional headache from a temporary rise in pressure inside the head that settles with dose adjustment, and a small increase in the risk of slipped hip and scoliosis that is caught by regular review. The long-term safety signal from the SAGhE mortality study is acknowledged with appropriate nuance: a possible small increase in all-cause and bone-tumour mortality in adults treated with growth hormone in childhood, with a very small absolute risk and substantial confounding, against which the benefit of treating a genuine growth hormone deficiency is clear. The candidate offers the parents written information and the contact details of the endocrine nurse specialist, and arranges a review of injection technique before the first dose is given at home. [4] [2]

The outlook is reassuring: most children respond well in the first year, the response is best when treatment is started early and taken consistently, and the aim is to reach an adult height within or close to the family's genetic potential. The candidate sets the expectation that therapy continues until near-final height and that a re-test at that point will decide whether treatment continues into adulthood. The consultation closes by acknowledging the parents' anxiety, normalising the injection burden with the support of the nurse specialist and peer groups, and confirming a clear follow-up plan. [1]