Unifying Concepts

Criteria to Initiate Evaluation for Growth Hormone Deficiency (GHD)

Tools for the diagnosis of GHD include auxology, radiographic assessment of bone age, measurement of insulin-like growth factor 1 (IGF-I) and IGF binding protein 3 (IGFBP-3), provocative growth hormone (GH) testing, cranial magnetic resonance imaging (MRI), and, in certain cases, genetic testing. Growth velocity and the degree of short stature are primary considerations in the decision to pursue evaluation for GHD.

Consensus Statement Criteria to Initiate Evaluation for GHD

  1. “Severe” short stature (height < −3 SD below mean)
  2. Height < −1.5 SD below mid-parental height
  3. Height < −2 SD below mean AND either height velocity < −1 SD below mean over past year or decrease in height SD of more than 0.5 SD over past year
  4. In the absence of short stature, height velocity < −2 SD below mean over 1 year OR < −1.5 SD below mean over 2 years
  5. Signs of an intracranial lesion
  6. Signs of multiple pituitary hormone deficiency
  7. Neonatal signs and symptoms of GHD, including hypoglycemia, prolonged jaundice, microphallus, or craniofacial midline abnormalities

SD: Standard Deviation



  1. Chinoy A, Murray PG. Diagnosis of growth hormone deficiency in the paediatric and transitional age. Best Pract Res Clin Endocrinol Metab. 2016 Dec;30(6):737-747. [Medline]
  2. Stanley T. Diagnosis of growth hormone deficiency in childhood. Curr Opin Endocrinol Diabetes Obes. 2012 Feb;19(1):47-52. [Medline]


Created Jul 01, 2019.

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