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More guidance on growth hormone deficiency
  1. R Ayling
  1. Correspondence to:
 Dr R Ayling
 Department of Clinical Chemistry, Derriford Hospital, Plymouth, Devon PL6 8DH, UK;

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Is it needed?

Growth is controlled and modulated by many factors, including nutritional, environmental, and endocrine mechanisms. During the 1st year of life, nutrition is the most important factor determining growth. Growth hormone (GH) is essential for growth throughout childhood, with sex steroids contributing to the pubertal growth spurt.

GH is released from the anterior pituitary gland under the influence of the opposing hypothalamic regulatory peptides, GH releasing hormone (GHRH) and somatostatin. The actions of GH are largely indirect, via insulin-like growth factors (IGFs), which exert negative feedback control on GH release. The GH releasing peptide ghrelin is the endogenous ligand for the GH secretagogue (GHS) receptor and induces a positive energy balance using an additional mechanism for GH control. It is produced predominantly by the stomach and appears to have a role in the integration of energy balance and growth.


GH deficiency (GHD) leads to a reduction in the generation of GH dependent factors, particularly IGF-I and its major binding protein IGF binding protein 3 (IGFBP3), which has auxological, clinical, and biochemical sequelae. Children with GHD are eligible for treatment with recombinant GH but their definition remains difficult. This difficulty in definition is reflected by the variability in prevalence in GHD from 287/million in the USA, to 20/million in the UK, and by the large proportion of children diagnosed who are subsequently found to have normal GH secretion unless strict auxological and biochemical criteria are used for diagnosis.1 Short stature may be the presenting feature of GHD, characteristically after a period of normal growth, yet the definition of short stature can itself be difficult.

Assessment of GHD

Assessment of an individual child’s growth requires information regarding the limits of normal variability, which can be obtained by plotting the height and height velocity on relevant curves derived from cross sectional and longitudinal …

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