Craig Alter, MD

This episode focuses on how GHD presents clinically in pediatric patients across different age groups and the quality-of-life implications of missed or delayed treatment. Dr. Alter explains that in newborns and infants, GHD often manifests as hypoglycemia — since both growth hormone and cortisol maintain blood glucose — and, in male infants, microphallus. Beyond the first few years, GHD typically presents later, most commonly between ages 10 and 13, and the severity of presentation tends to correlate with age of onset. Younger patients are more likely to have organic or structural causes. The panel discusses the challenge of distinguishing true GHD from physiologic pre-pubertal growth deceleration. Dr. Yang notes that in the U.S., there is a tendency to treat borderline cases, whereas European colleagues may take a watch-and-wait approach. Data suggests that roughly half of these pre-pubertal patients may self-correct once puberty begins and retest as normal. When GHD is genuine and left untreated, consequences extend beyond height. Dr. Alter describes improvements in muscle mass, fat distribution, bone health, and cardiovascular markers following GH therapy. Patients — especially those with severe GHD — typically show excitement and marked improvement with treatment. The panel also tackles the nuanced case of a short child with a normal height velocity but a much taller mid-parental target height. Dr. Alter notes that growth genetics are complex (over 180 genes involved) and a comprehensive workup including extended family history is warranted. Treatment decisions must also factor in family preferences, as some families decline GH therapy even when medically indicated. The episode closes with discussion of broader GH indications beyond GHD, including idiopathic short stature (ISS) and other genetic syndromes qualifying for GH therapy. In the next episode, “Diagnosing Growth Hormone Deficiency in Children — Testing, Tools, and Decision-Making,” the panel outlines the step-by-step diagnostic approach to suspected pediatric GHD, including the role of IGF-1, stimulation testing, and imaging.

Recognizing Growth Hormone Deficiency — Symptoms, Presentation, and Quality of Life

This episode focuses on how GHD presents clinically in pediatric patients across different age groups and the quality-of-life implications of missed or delayed treatment.

Dr. Alter explains that in newborns and infants, GHD often manifests as hypoglycemia — since both growth hormone and cortisol maintain blood glucose — and, in male infants, microphallus. Beyond the first few years, GHD typically presents later, most commonly between ages 10 and 13, and the severity of presentation tends to correlate with age of onset. Younger patients are more likely to have organic or structural causes.

The panel discusses the challenge of distinguishing true GHD from physiologic pre-pubertal growth deceleration. Dr. Yang notes that in the U.S., there is a tendency to treat borderline cases, whereas European colleagues may take a watch-and-wait approach. Data suggests that roughly half of these pre-pubertal patients may self-correct once puberty begins and retest as normal.

When GHD is genuine and left untreated, consequences extend beyond height. Dr. Alter describes improvements in muscle mass, fat distribution, bone health, and cardiovascular markers following GH therapy. Patients — especially those with severe GHD — typically show excitement and marked improvement with treatment.

The panel also tackles the nuanced case of a short child with a normal height velocity but a much taller mid-parental target height. Dr. Alter notes that growth genetics are complex (over 180 genes involved) and a comprehensive workup including extended family history is warranted. Treatment decisions must also factor in family preferences, as some families decline GH therapy even when medically indicated.

The episode closes with discussion of broader GH indications beyond GHD, including idiopathic short stature (ISS) and other genetic syndromes qualifying for GH therapy.

Diagnosing Growth Hormone Deficiency in Children — Testing, Tools, and Decision-Making

,” the panel outlines the step-by-step diagnostic approach to suspected pediatric GHD, including the role of IGF-1, stimulation testing, and imaging.

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Endocrinology experts compare pediatric and adult growth hormone deficiency—causes, testing, MRI use, and transition care tips to improve outcomes.

Welcome back to another HCP Live Peer Exchange series. In this episode titled “Unraveling Growth Hormone Deficiency — Etiology and Prevalence,” moderator Dr. Joshua Yang discusses growth hormone deficiency with Dr. Craig Alter, Dr. Jose Garcia, and Dr. Nidhi Agrawal. In this opening episode, the panel introduces the HCP Live Peer Exchange series focused on Managing Growth Hormone Deficiency Across the Continuum of Care. Dr. Joshua Yang sets the stage by outlining the program’s scope, which encompasses diagnosis, treatment decision-making, transition of care, and real-world clinical challenges across both pediatric and adult populations. Dr. Yang begins by discussing the prevalence of GHD in children. Worldwide, GHD affects approximately 1 in 4,000 to 1 in 10,000 children, though in the U.S. the rate is closer to 1 in 3,000 — likely because American clinicians tend to treat milder and moderate cases, and use a higher GH peak cutoff of 10 ng/mL versus the European standard of 7 ng/mL. Dr. Garcia adds that adult GHD is estimated at 1 in 50,000 to 1 in 100,000 individuals, though emerging data suggests higher prevalence — with up to 10–15% of patients with prior head trauma also harboring GHD. The panel then explores etiologies. In children, causes are often congenital (midline defects, pituitary genetic mutations) or idiopathic. Dr. Alter stresses that the primary clinical priority is always accurate diagnosis before treatment — illustrated by a case of a craniopharyngioma initially presenting only as delayed puberty. For adults, structural causes dominate: pituitary adenomas, craniopharyngiomas, radiation, surgery, stroke, or trauma. The episode closes with a discussion of idiopathic pediatric GHD patients — often mild or moderate cases — and the question of whether they carry GHD into adulthood. The consensus is that retesting is essential, and that IGF-1 alone is not reliable enough to confirm or exclude adult GHD. In the next episode, “Recognizing Growth Hormone Deficiency — Symptoms, Presentation, and Quality of Life,” the panel explores how GHD presents at different ages in children and the long-term consequences of undiagnosed or undertreated GHD.

Unraveling Growth Hormone Deficiency — Etiology and Prevalence

Welcome back to another HCP Live Peer Exchange series. In this episode titled “Unraveling Growth Hormone Deficiency — Etiology and Prevalence,” moderator Dr. Joshua Yang discusses growth hormone deficiency with Dr. Craig Alter, Dr. Jose Garcia, and Dr. Nidhi Agrawal.

In this opening episode, the panel introduces the HCP Live Peer Exchange series focused on Managing Growth Hormone Deficiency Across the Continuum of Care. Dr. Joshua Yang sets the stage by outlining the program’s scope, which encompasses diagnosis, treatment decision-making, transition of care, and real-world clinical challenges across both pediatric and adult populations.

Dr. Yang begins by discussing the prevalence of GHD in children. Worldwide, GHD affects approximately 1 in 4,000 to 1 in 10,000 children, though in the U.S. the rate is closer to 1 in 3,000 — likely because American clinicians tend to treat milder and moderate cases, and use a higher GH peak cutoff of 10 ng/mL versus the European standard of 7 ng/mL.

Dr. Garcia adds that adult GHD is estimated at 1 in 50,000 to 1 in 100,000 individuals, though emerging data suggests higher prevalence — with up to 10–15% of patients with prior head trauma also harboring GHD.

The panel then explores etiologies. In children, causes are often congenital (midline defects, pituitary genetic mutations) or idiopathic. Dr. Alter stresses that the primary clinical priority is always accurate diagnosis before treatment — illustrated by a case of a craniopharyngioma initially presenting only as delayed puberty. For adults, structural causes dominate: pituitary adenomas, craniopharyngiomas, radiation, surgery, stroke, or trauma.

The episode closes with a discussion of idiopathic pediatric GHD patients — often mild or moderate cases — and the question of whether they carry GHD into adulthood. The consensus is that retesting is essential, and that IGF-1 alone is not reliable enough to confirm or exclude adult GHD.

,” the panel explores how GHD presents at different ages in children and the long-term consequences of undiagnosed or undertreated GHD.

Experts compare pediatric vs adult growth hormone deficiency—causes, testing, MRI use, and why retesting matters during transition to adult care.

Craig Alter, MD

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