Growth Hormone Resistance Workup

Updated: Jan 15, 2019
  • Author: Arlan L Rosenbloom, MD; Chief Editor: Robert P Hoffman, MD  more...
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Workup

Laboratory Studies

Please refer to Hyposomatotropism and Short Stature for the complete workup for growth failure. Note the following:

  • GH is elevated in childhood in GHRD but may be normal in adults; response to stimulation is above normal in children and adults. See Table in the Background section for other conditions.

  • IGF-I and IGFBP3 are very low in GHRD. See Table in the Background section for other conditions.

  • GHBP is low or absent in GHRD, except for mutations at the transmembrane region, which result in increased GHBP. See Table in the Background section for other conditions.

  • Home blood glucose monitoring may be considered for infants and young children to monitor for hypoglycemia (typically controlled by frequent feeding).

  • Lipid profile is appropriate for adults with GHRD.

  • Mutational analyses should be obtained in consultation with one of the few laboratories analyzing the GH-IGF-I axis.

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Imaging Studies

A left hand and wrist radiograph can be used to assess osseous maturation as is done with any other growth disorder. 

A hip radiograph series may be indicated to assess for Legg-Perthes disease (aseptic necrosis of the capital femoral epiphysis).

Patients being treated with rhIGF-I may need radiographic studies of the upper airway to screen for the common adverse effect of lymphoid hyperplasia, which often requires tonsillectomy/adenoidectomy. 

Brain imaging studies may be required because of the adverse effect of intracranial hypertension.

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