Symptoms of Pediatric Growth Hormone Deficiency

Pediatric growth hormone deficiency is a condition that causes slowed growth in a child as a result of malformation of or damage to the pituitary gland or hypothalamus. The pituitary gland is involved in the production of growth hormone, while the hypothalamus helps regulate the pituitary gland. Injury to or issues with either organ may reduce the production of growth hormone, which helps stimulate the growth of bones and other tissues. Symptoms of pediatric growth hormone deficiency usually include short stature, chubby build, younger-looking face, and absent or delayed puberty. Children with pediatric growth hormone deficiency have normal body proportions and are not cognitively delayed. 

Frequent Symptoms

When a child’s pituitary gland does not produce enough growth hormone, the rate of growth slows or stops. This can lead to other effects in the body such as absent puberty.

While each case may vary, the most common symptoms of pediatric growth hormone deficiency include:

• Short stature: Children with growth hormone deficiency are shorter than their peers.
• Slow growth curve: Children with this condition grow at a very slow rate. Their growth charts, which pediatricians use to monitor height and weight, usually appear slow or flat. This slowed growth curve usually appears at around age 2 or 3 years old.
• Chubby build: Without sufficient growth hormone, children keep a younger body shape, rather than losing their baby fat as they age. 
• Youthful features: A child with pediatric growth hormone deficiency has a younger-looking face with youthful features and a round shape. 
• Baby teeth: Without an adequate supply of growth hormone, many children with pediatric growth hormone deficiency show a delay in tooth development. An X-ray will often show that their bones also appear younger than their chronological age.
• Delayed puberty: Without an adequate supply of growth hormone to stimulate puberty, a child with this condition does not experience the changes of puberty. Puberty can sometimes come on later, especially once the child is treated with human growth hormone injections.

Children with pediatric growth hormone deficiency may also have a prominent forehead and an underdeveloped bridge of the nose.

Rare Symptoms

Pediatric growth hormone deficiency is almost always first identified because of slowed growth. Once your child’s growth curve appears to slow or flatten, your pediatrician will talk with you about possible causes and pursue testing.

Rarely, more serious findings and symptoms can present with growth hormone deficiency:

• Growth hormone insensitivity: Rarely, children with short stature and slowed growth have a normal level of growth hormone in their bodies. The issue is with their growth hormone receptors. When growth hormone receptors are not functioning properly, the body cannot use growth hormone, and thus growth slows. 
• Hypoglycemia: When the pituitary gland or hypothalamus is not functioning properly, the pituitary gland fails to produce growth hormone and other hormones. Some infants and children experience hypoglycemia due to a damaged pituitary gland. Hyperbilirubinemia is also possible. 
• Cleft palate: If your child was born with growth hormone deficiency, the cause may be genetic. In this case, other organs and body systems affected by the pituitary gland will also show abnormalities. 
• Brain tumor: The cause of pediatric growth hormone deficiency is often unknown. Rarely, the cause for the deficiency is a brain tumor, such as craniopharyngioma, that is pressing on the pituitary gland or hypothalamus. 

Complications

There are complications of pediatric growth hormone deficiency depending on the underlying cause and chosen treatment:

• Low bone density: Because growth hormone is needed for bone maturation, a deficiency causes immature bones that lack density. This is due to the reduced bone formation found in children with pediatric growth hormone deficiency. Research has shown that adults with growth hormone deficiency are at higher risk of osteoporosis and fractures. Fortunately, bone density can be improved with the treatment of growth hormone injections. 
• Cardiovascular disease: Children with growth hormone deficiency are at increased risk of developing impaired cardiac function and dyslipidemia, probably due to an increased level of atheromatous plaque related to inadequate growth hormone. 
• Treatment side effects: While treatment for pediatric growth hormone deficiency can be very effective, it can cause serious side effects. The recommended treatment for this condition is growth hormone injections. Since growth hormone affects multiple body systems, different side effects can develop, including hypertension, slipped capital femoral epiphysis, and worsening of scoliosis symptoms. Your pediatric endocrinologist will work closely with you to monitor your child's health and make treatment adjustments as needed. 

When to See a Doctor

Most children are diagnosed with pediatric growth hormone deficiency because of an initial slow or flat growth chart. Attending each of your child’s scheduled well-child appointments with the pediatrician is crucial for monitoring your child’s growth and recognizing a problem early. 

It can be difficult for parents to notice delayed growth because we see our children every day. That is why an updated growth chart is helpful in spotting slowing of growth and addressing it right away. 

There are several possible reasons for a child’s short stature besides pediatric growth hormone deficiency. Many other conditions such as celiac disease and decreased nutritional intake can cause similar symptoms. If you are concerned about your child’s growth, talk with your pediatrician. 

A Word From Verywell

Children grow up at varying rates, so symptoms of pediatric growth hormone deficiency may be difficult to recognize at first. Once it appears that your child’s growth has slowed or stopped, talk to your pediatrician about evaluating your child for conditions that may be contributing to this and work closely with them to monitor growth. It is distressing to know that your child has pediatric growth hormone deficiency, but this condition is treatable with human growth hormone injections and other therapies. Over time, your child can still grow to a "normal" height and live a happy and healthy life.