Growth hormone deficiency in children

Last reviewed: 28 Apr 2022
Last updated: 01 Feb 2022

Summary

Definition

History and exam

Key diagnostic factors

  • parental consanguinity
  • short stature
  • poor growth velocity
  • short for target height
  • absent pubertal growth spurt ± delayed puberty
  • central nervous system (suprasellar) tumor symptoms
  • symptoms of other pituitary hormone dysfunction
  • characteristic facial appearance
More key diagnostic factors

Other diagnostic factors

  • assisted birth
  • visual impairment
  • associated dysmorphic features
  • focal neurologic deficits
  • hyperphagia/obesity
  • temperature dysregulation/sleep disorder
  • behavioral problems
Other diagnostic factors

Risk factors

  • family history of GHD
  • other pituitary hormone deficiencies
  • central nervous system (CNS) tumors/cysts
  • radiation therapy
  • midline abnormalities
  • CNS infiltrative disorders
  • perinatal complications
  • CNS trauma
  • preexisting iron overload disorder
  • child abuse
  • CNWS infections
More risk factors

Diagnostic investigations

1st investigations to order

  • x-ray wrist
  • thyroid function tests
  • IGF1 and IGFBP3
  • baseline pituitary function tests
  • basic hematology and biochemistry screen
More 1st investigations to order

Investigations to consider

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

Treatment algorithm

ACUTE

confirmed GH deficiency

Contributors

Authors

Hoong-Wei Gan, BMedSci (Hons), BMBS, MSc, PhD, MRCPCH

Consultant Paediatric Endocrinologist

Great Ormond Street Hospital for Children NHS Foundation Trust

London

UK

Disclosures

HWG has received educational grants and had travel expenses and hospitality paid for by Ipsen and Novo Nordisk for international meetings. He has received lecture fees from Ipsen. HWG is Deputy Chair of the UK National Paediatric Craniopharyngioma Guideline Development Group and is an author of references cited in this topic.

Harshini Katugampola, BSc, MBBS, MSc, PhD, MRCPCH

Consultant Paediatric Endocrinologist

Great Ormond Street Hospital for Children NHS Foundation Trust

London

UK

Disclosures

HK has had registration expenses paid for by Novo Nordisk for international meetings. HK is an author of references cited in this topic.

Acknowledgements

Dr Hoong-Wei Gan and Dr Harshini Katugampola would like to gratefully acknowledge Dr Ameeta Mehta, Professor Mehul T. Dattani, and Dr Kyriaki S. Alatzoglou, previous contributors to this topic.

Disclosures

AM is an author of references cited in this topic. MTD received lecture fees from Novo Nordisk, Pfizer, and Ipsen; consultancy fees from Novo Nordisk, Pfizer, Ipsen, and Sandoz; and was 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 program. MTD declared that none of these activities are related to this topic. MTD is an author of references cited in this topic. KSA is an author of references cited in this topic.

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

London

UK

Disclosures

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

NY

Disclosures

PS declares that he has no competing interests.

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