Growth hormone deficiency classification

Growth hormone deficiency can be classified by cause into congenital, acquired or idiopathic. In the congenital type, infants show symptoms such as hypoglycemia, neonatal growth failure, neonatal jaundice, and asphyxia. In acquired type of growth hormone deficiency, patients present with severe growth failure, delayed bone age, delayed puberty. The Idiopathic growth hormone deficiency which is defined as having a height significantly shorter than the normal population with no attributable cause for short stature.

Growth hormone deficiency can be classified into 3 based on the cause into:

• Symptoms manifest on the first day of life however, in some cases symptoms do not present until 6 months of life.
• Congenital growth hormone deficiency can be classified into three subtypes:
  • Growth hormone deficiency IA: It is an autosomal recessive disease characterized by growth retardation in utero. Affected children are small in relation to their siblings. The infant has a normal response to administration of human growth hormone (hGH) at first, but then develops antibodies to the hormone and grows into a very short adult.^[1]
  • Growth Hormone Deficiency IB: It is also autosomal recessive and similar to IA. This is due to decreased levels of growth hormone (GH) present in the child at birth. This child continues to respond to GH treatments.^[2]
  • Growth Hormone Deficiency IIB and III: they are similar to IB, but IIB is autosomal dominant and III is X-linked.^[3]

• It may first appear in children or adults. Children with GHD present with severe growth failure, delayed bone age, delayed puberty, immature face with an underdeveloped nasal bridge, frontal bossing, sparse hair growth, and infantile fat distribution.^[4]
• Adults with GHD can be grouped into those who had prior childhood GHD, those who acquire GHD secondary to structural lesions or trauma, and those with idiopathic GHD. Childhood GHD is generally further divided into those with organic causes and those in whom the cause is unknown.^[5]

• Idiopathic growth hormone deficiency is defined as having a height significantly shorter than the normal population with no attributable cause for short stature.^[6]
• Idiopathic growth hormone deficiency is generally defined as having less than the calculated mid-parental height.
• The clinical and biological presentation of idiopathic growth hormone deficiency varies, demonstrating the variety of its pathogenic features.^[7]

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