Duche et al developed a clinical decision rule for deciding which short-statured children should be tested for a growth hormone deficiency. This can help to reduce unnecessary laboratory testing. The authors are from multiple hospitals in Paris.


Patient selection: age 1 to 16 with one or more features of growth hormone deficiency


A patient underwent a growth hormone stimulation test only if s/he had both of the following:

(1) growth rate < - 1SD

(2) serum insulin-like growth factor I (IGF-1) concentration < -2 SD



• IGF-1 is reported in mg/L or ng/mL/

• An IGF-1 < - 2SD is at the low end of the reference range or below. Many reference ranges are set at mean +/- -2.5 SD.


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