Last reviewed: 21 Sep 2021
Last updated: 16 Feb 2018



History and exam

Key diagnostic factors

  • short stature
  • poor growth velocity
  • short for target height
  • absent pubertal growth spurt ± delayed puberty
  • CNS (suprasellar) symptoms
  • characteristic facial appearance

Other diagnostic factors

  • assisted birth
  • neonatal complications
  • undescended testes/small penis
  • visual impairment
  • associated dysmorphic features
  • focal neurologic deficits
  • hyperphagia/obesity
  • temperature dysregulation/sleep disorder
  • behavioral problems

Risk factors

  • FHx of GHD
  • other pituitary hormone deficiency
  • CNS tumors/cysts
  • radiation therapy
  • midline abnormalities
  • CNS infiltrative disorders
  • perinatal complications
  • CNS trauma
  • pre-existing iron overload disorder
  • child abuse
  • CNS infections

Diagnostic investigations

Investigations to consider

  • GH provocation test
  • MRI brain
  • CT brain/x-ray skull
  • full pituitary hormone evaluation
  • specialist referral
  • genetic studies
  • random GH

Treatment algorithm



Ameeta Mehta, MBBS, DCH, DNBE, MSc, MRCP, MD
Ameeta Mehta

Paediatric Endocrinologist




AM is an author of several references cited in this topic.

Mehul T. Dattani, MBBS, DCH, FRCPCH, FRCP, MD
Mehul T. Dattani

Professor of Paediatric Endocrinology

Consultant in Paediatric and Adolescent Endocrinology

Great Ormond Street Hospital for Children and

University College London Hospitals




MTD has received lecture fees from Novo Nordisk, Pfizer, and Ipsen; consultancy fees from Novo Nordisk, Pfizer, Ipsen, and Sandoz; and is a member of a Novo Nordisk advisory board. Novo Nordisk, Pfizer, Ferring, Ipsen, Lilly, Merck, and Serono have made financial contributions to MTD's departmental teaching programme. MTD declares that none of these activities are related to this topic. MTD is an author of a number of references cited in this topic.


Dr Ameeta Mehta and Dr Mehul T. Dattani would like to gratefully acknowledge Dr Kyriaki S. Alatzoglou, a previous contributor to this topic. KSA is an author of a number of references cited in this monograph.

Peer reviewers

Martin Savage, MA, MD, FRCP, MRCPCH

Professor of Paediatric Endocrinology (Emeritus)

Department of Endocrinology

William Harvey Research Institute

St Bartholomew's and the Royal London School of Medicine and Dentistry

John Vane Science Centre




MS has received honoraria and consultancy payments from Ipsen, Pfizer, Novo Nordisk, and Merck Serono.

Paul Saenger, MD, MACE

Professor of Pediatrics

Department of Pediatrics (Endocrinology)

Montefiore Medical Center

Albert Einstein College of Medicine

New York



PS declares that he has no competing interests.

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