Diagnosing growth hormone deficiency (GHD) in children lacks a gold standard, relying on auxology—height SDS below -2, faltering velocity, delayed bone age—while excluding mimics like hypothyroidism or chronic illness. Provocative GH stimulation tests show poor reproducibility due to assay variability, nutrition, and puberty effects; IGF-I levels overlap with normals, demanding two stimuli with cutoffs <7-10 µg/L. MRI detects pituitary anomalies in severe cases, but retesting at adulthood transition is crucial as childhood GHD may resolve.
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