title: Assessing short-statured children for growth hormone deficiency.
abstract: OBJECTIVE
  To optimize the workup of short-statured children by defining the most appropriate tools for diagnosing growth hormone (GH) deficiency.
  
  
  METHODS
  Patients were assigned to prepubertal (n = 113) or pubertal (n = 112, including 25 boys primed with testosterone) age groups. Mean plasma GH concentration during sleep, GH peak after provocative test, and insulin-like growth factor I (IGF-I) were measured in a single evaluation.
  
  
  RESULTS
  The mean GH concentration during sleep was more often normal (n = 155) than the GH peak after provocative tests (n = 105) or the IGF-I concentration (n = 88). Prepubertal patients with a normal body mass index (BMI) had mean GH concentrations during sleep that correlated positively with height, growth rate, GH peak after provocative tests, and IGF-I (p < 0.0005 for all) and negatively with the difference between target and patient heights (p = 0.01) and BMI (p < 0.05). Pubertal patients with a normal BMI had a mean GH concentration during sleep that correlated positively with GH after provocative tests (p < 0.0001) and IGF-I (p < 0.005). Mean GH concentration during sleep and IGF-I concentration for boys primed with testosterone were more often normal (n = 23) than the GH peak after provocative tests (n = 14). All 9 patients with pituitary stalk interruption had low IGF-I concentrations; 1 patient had a normal GH peak after provocative test, and 2 patients had normal mean GH concentrations during sleep.
  
  
  CONCLUSIONS
  Measuring the GH concentration during sleep and priming boys with pubertal delay can help to exclude idiopathic GH deficiency. Magnetic resonance imaging is needed to exclude anatomic abnormalities when GH and/or IGF-I concentrations are low.
authors.affiliation: Université René-Descartes and Pediatric Endocrinology Unit, Hôpital Necker-Enfants-Malades, Assistance Publique-Hôpitaux de Paris, France.
authors.forename: W
authors.initials: W
authors.lastname: Chemaitilly
authors.forename: C
authors.initials: C
authors.lastname: Trivin
authors.forename: J-C
authors.initials: JC
authors.lastname: Souberbielle
authors.forename: R
authors.initials: R
authors.lastname: Brauner
mesh_terms: D000293:Adolescent; D001827:Body Height / Q000502:physiology*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006130:Growth Disorders / Q000097:blood / Q000175:diagnosis*; D019382:Human Growth Hormone / Q000172:deficiency* / Q000378:metabolism; D006801:Humans; D007223:Infant; D007334:Insulin-Like Growth Factor I / Q000378:metabolism; D008297:Male; D011627:Puberty / Q000502:physiology; D012016:Reference Values; D012189:Retrospective Studies; D012890:Sleep / Q000502:physiology; D013268:Stimulation, Chemical; D013739:Testosterone
chemical_list: D019382:Human Growth Hormone; D013739:Testosterone; D007334:Insulin-Like Growth Factor I