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]