Can we diagnose growth hormone deficiency?

The diagnosis of childhood growth hormone deficiency remains a controversial area, despite dramatic progress in therapy. The ability to definitively diagnose growth hormone deficiency is based on provocative tests that are nonphysiologic, invasive, and often risky. With the recent advancements in the insulin-like growth factor field, alternative methods for assessing growth hormone deficiency are available. The aim of all such diagnostic tests should be to complement the clinical evaluation, which remains the foundation for diagnosis of growth hormone deficiency. Further progress in cellular and molecular biology will enhance our ability to distinguish between children with abnormalities of the growth hormone - insulin-like growth factor axis and children with idiopathic short stature. It may be more productive, ultimately, to identify children with insulin-like growth factor deficiency, rather than growth hormone deficiency.