Managing Growth Hormone Deficiency Across the Continuum of Care - Episode 2
Recognizing Growth Hormone Deficiency — Symptoms, Presentation, and Quality of Life
Endocrinology experts compare pediatric and adult growth hormone deficiency—causes, testing, MRI use, and transition care tips to improve outcomes.
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.
