[Evaluating diagnosis methods on childhood GH (DGH) deficiency: IGFs, IGFBPs, releasing tests, GH rhythm and image exams].

The diagnostic approach to growth hormone deficiency (GHD) in children with short stature (SS) is controversial. Here we review the available methodology and present prospective data obtained in a cohort of patients with SS suggesting the use of screening test followed by the confirmation test. Thus, the children with SS should be submitted to clinical and laboratorial evaluation to exclude of chronic and genetic diseases. In addition patients with height<3 percentile or growth velocity<percentile 25, IGF-1 levels should be measured. If the IGF1 levels<-1 standard deviation (SD) compared to the age, GHD should be confirmed by two GH-stimulations tests (peak<5 mcg/L). In risk factor patients, IGF-1<-1 SD and one non-responsible GH-test, the GHD was confirmed. Children with IGF-1>-1 SD, the growth velocity should have observed and GH/IGF-1 axis re-evaluated if the growth pattern is not satisfactory.