# Transient Isolated, Idiopathic Growth Hormone Deficiency—A Self-Limiting Pediatric Disease with Male Predominance or a Diagnosis Based on Uncertain Criteria? Lesson from 20 Years’ Real-World Experience with Retesting at One Center

## TL;DR

Many children diagnosed with growth hormone deficiency naturally recover before reaching final height, suggesting possible overdiagnosis.

## Contribution

The study shows that applying stricter diagnostic criteria reduces GHD diagnoses but does not eliminate transient cases.

## Key findings

- A high proportion of children with idiopathic GHD showed normal GH secretion before reaching near-final height.
- Poor GH therapy response was linked to normal IGF-1 levels before treatment, suggesting potential false GHD diagnoses.
- Stricter diagnostic criteria reduced GHD diagnoses but did not lower the rate of transient GHD cases.

## Abstract

In the majority of children with growth hormone (GH) deficiency (GHD), normal GH secretion may occur before the attainment of final height. The aim of the study was to assess the incidence of persistent and transient GHD and the effectiveness of recombined human GH (rhGH) therapy in children with isolated, idiopathic GHD with respect to the moment of therapy withdrawal and according to different diagnostic criteria of GHD. The analysis included 260 patients (173 boys, 87 girls) with isolated, idiopathic GHD who had completed rhGH therapy and who had been reassessed for GH and IGF-1 secretion. The incidence of transient GHD with respect to different pre- and post-treatment criteria was compared together with the assessment of GH therapy effectiveness. The incidence of transient GHD, even with respect to pediatric criteria, was very high. Normal GH secretion occurred before the attainment of near-final height. Application of more restricted criteria decreased the number of children diagnosed with GHD but not the incidence of transient GHD among them. Poor response to GH therapy was observed mainly in the patients with normal IGF-1 before treatment, suggesting that their diagnosis of GHD may have been a false positive. Further efforts should be made to avoid the overdiagnosis GHD and the overtreatment of patients.