When are we diagnosing growth hormone deficiency?

The height and age at presentation of 458 children beginning treatment with growth hormone between January 1980 and June 1984 were retrospectively analysed. Three hundred and nine children with isolated growth hormone deficiency had a mean (SD) age of 10 (4.1) years on beginning treatment and a mean (SD) height standard deviation score (SDS) of -3.73 (0.93). One hundred and nine patients with hypothalamopituitary tumours began treatment with growth hormone on average 3.3 years after diagnosis of the tumour and at a mean (SD) height SDS of -2.42 (1.49). In both of these categories the height SDS showed a considerable improvement compared with previous reports. Forty two patients with growth hormone deficiency secondary to cranial irradiation started treatment with growth hormone on average 6.1 years after treatment for their tumours and had a height SDS of -2.45 (1.02) compared with that of -2.45 (0.98) seen in nine similar patients from the United Kingdom starting treatment with growth hormone between 1975 and 1978. Although closer surveillance of short children in the community is leading to earlier diagnosis of growth hormone deficiency, this could possibly be diagnosed earlier if routine screening of height was to be carried out at school entry. In addition, patients who have received cranial irradiation should be regularly measured and investigated when their height velocity becomes subnormal.