Screening
Short stature and a poor growth velocity should warrant review by a family practitioner. Accurate measurements, using correct age- and sex-specific growth charts, are mandatory. Care must be taken to plot the height and weight based on the child's actual chronological age.
Growth is strongly related to genetic potential. The target or mid-parental height is calculated as follows:
Girl = (height of mother in cm + height of father in cm)/2 - 6.5 cm
Boy = (height of mother in cm + height of father in cm)/2 + 6.5 cm.
Growth velocity determines the change in height over time. It is calculated as the difference in height on 2 different occasions annualised over 1 year. Growth velocities depend on age and pubertal status. Height that plots stably along a given percentile on the growth chart reflects normal growth velocity. Crossing percentiles in a downward direction reflects poor growth velocity.
Investigations for GHD and referral to a paediatric endocrinologist are indicated in any child with:[30]
Severe short stature (height >3 standard deviation scores [SDS] below mean for population)
Height >2 SDS below mean and a growth velocity over 1 year of >1 SDS below mean or a decrease in the height SDS of >0.5 over 1 year in children >2 years of age
Height SDS >1.5 SDS below target height SDS
Height velocity >2 SDS below mean over 1 year or >1.5 SDS over 2 years in the absence of short stature
Positive family history
An intracranial lesion
Combined pituitary hormone deficiencies (CPHD)
Post-cranial irradiation.
It is also important to remember that pituitary hormone deficiencies can evolve, so regular and often lifelong monitoring, both clinically and with investigations, is needed.
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