This first longitudinal OP/HSG-specific study demonstrates that hypothalamo-pituitary dysfunction evolves hierarchically over decades. Tumor location predicts its speed of onset and radiotherapy its density. GnD can evolve from previous CPP, whereas life-threatening PPD can occur after any surgery. Our data suggest that recent radiation-avoiding chemotherapeutic strategies have increased GHD without improving survival.

Growth hormone (GH) deficiency (GHD) in children is defined as impaired production of GH by the pituitary gland that results in growth failure. This disease may be congenital or acquired, and occurs in isolation or in the setting of multiple pituitary hormone deficiency (MPHD). Isolated GHD has an estimated prevalence of 1 patient per 4,000-10,000 livebirths and can be due to multiple causes, some of which are yet to be determined. Establishing the correct diagnosis remains key in children with short stature, as initiating treatment with recombinant human GH can help them attain their genetically determined adult height. During the past 2 decadesour understanding of the benefits of continuing GH throughout the transition period from childhood to adulthood has increased. Improvements in transitional care will help alleviate the consequent physical and psychological problems that can arise from adult GHD, although the consequences of lack of hormone replacement are less severe in adults than in childhood. In this manuscript, we review the differential diagnosis in children with GHD, including details of clinical presentation, neuroimaging, and genetic testing. Furthermore, we highlight advances and issues in management of GHD, including details of transitional care.