pediatrics
Growth Hormone Deficiency in Children
Symptoms and Signs of Growth Hormone Deficiency
Manifestations of growth hormone deficiency depend on the patient's age, the underlying etiology, and the specific hormone deficiencies. Growth hormone deficiency itselftypically manifests as growth failure, sometimes along with delay in tooth development. Height is below the 3rd percentile, and growth velocity is<6 cm/year before age 4 years,<5 cm/year from age 4 to 8 years, and<4 cm/year 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 years behind chronologic age. Other abnormalitiesmay be present, depending on the underlying defect, and the child may have delayed or absent pubertal development. Weight gain may be out of proportion to growth, resulting in relative obesity. Neonates who have congenital defects of the pituitary or hypothalamus may have hypoglycemia (which also can occur in older children), hyperbilirubinemia, midline defects (eg, cleft palate), or micropenis, as well as manifestations of other endocrine deficiencies. 