Growth hormone (GH) deficiency is the most common pituitary hormone deficiency in children and can be isolated or accompanied by deficiency of other pituitary hormones. GH deficiency typically results in abnormally slow growth and short stature with normal proportions. Diagnosis involves measurement of pituitary hormone levels and CT or MRI to detect structural pituitary anomalies or brain tumors. Treatment usually involves specific hormone replacement and removal of any causative tumor.GH deficiency itself typically manifests as growth failure, sometimes along with delay in tooth development. Height is below the 3rd percentile, and growth velocity is < 6 cm/yr before age 4 yr, < 5 cm/yr from age 4 to 8 yr, and < 4 cm/yr before puberty. Although of small stature, a child with hypopituitarism retains normal proportionality between upper and lower body segments. Skeletal maturation, assessed by bone age determination, is > 2 yr behind chronologic age
DIAGNOSIS
Clinical evaluation, including growth criteria and other medical history
Imaging studies
Insulin-like growth factor 1 (IGF-1) levels and IGF binding protein type 3 (IGFBP-3) levels
TREATMENT
Recombinant GH supplements
Sometimes other pituitary hormone replacement
Usually confirmation by provocative testing
Evaluation of other pituitary hormones and for other causes of poor growth