Etiology of growth hormone deficiency in children and adolescents

Abstract

Growth hormone deficiency (GHD) can be isolated or associated with deficiency of other pituitary gland hormones. According to age at diagnosis, causes of GHD are divided into congenital or acquired, and according to etiology into recognized and unknown. We analyzed etiology and prevalence of GHD, demographic data at birth, age, body height (BH) and bone age at diagnosis as well as the frequency of other pituitary hormone deficiencies. The study involved 164 patients (109 male).The main criterion for the diagnosis of GHD was inadequate response of GH after two stimulation tests.The patients were classified into three groups: idiopathic, congenital and acquired GHD. Idiopathic GHD was confirmed in 57.9% of patients, congenital in 11.6% and acquired in 30.5%. The mean age at diagnosis of GHD was 10.1 +/- 4.5 years.The patients with congenital GHD had most severe growth retardation (-3.4 +/- 1.4 SDS), while the patients with idiopathic GHD showed most prominent bone delay (-3.6 +/- 2.3 SDS).The prevalence of multiple pituitary hormone deficiency was 56.1%, in the group with congenital GHD 73.7%, acquired GHD 54.0% and idiopathic GHD 53.7%.The frequency of thyrotropin deficiency ranged from 88.2-100%, of adrenocorticotrophin 57.1-68.8% and of gonadotrophins deficiency 57.1-63.0%, while deficiency of antidiuretic hormone was 2.0-25.0%. Although regular BH measurements enable early recognition of growth retardation, patients' mean age and degree of growth retardation indicate that GHD is still diagnosed relatively late. A high incidence of other pituitary hormone deficiencies requires a detailed investigation of the etiology of disorders and evaluation of all pituitary functions in each child with confirmed GHD.