. Hydroxyproline excretion in various forms of growth failure. The hydroxyproline excretion in 24-hour urines was determined in 26 children and adolescents whose heights were below the 3rd centile. In 14 growth failure was related to endocrine defects, and in 12 growth failure was unrelated to endocrine defect. The normal range of urinary hydroxyproline excretion at different ages was determined in 40 normal children aged between 3 and 14 years. All subjects were placed on a hydroxyproline-free diet before and during urine collections. Hydroxyproline excretion was expressed as mg/m2 body surface per 24 hr.Children with pituitary and hypothyroid dwarfism had decreased excretion of hydroxyproline. Giving growth hormone and/or thyroid hormone raised the hydroxyproline excretion to normal. Children with growth failure unrelated to endocrine defect had normal hydroxyproline excretion.During childhood, urinary hydroxyproline excretion provides a useful means for distinguishing between endocrine dwarfism (low excretion) and non-endocrine dwarfism (normal excretion). In older adolescents and adults it is less reliable.The amino acid hydroxyproline is formed by hydroxylation of proline within the collagen (for review see Adams, 1970), and 95% of urinary hydroxyproline is derived from collagen in bones. Under conditions of a hydroxyproline-free diet the urinary excretion of hydroxyproline can be considered a parameter of bone metabolism and bone growth (for reviews see Kivirikko, 1970;Sjoerdsma et al., 1965).Varying levels of hydroxyproline in 24-hour urines have been described in connexion with several skeletal disorders (Burkhardt, Dietrich, and Rommel, 1970;Filliat et al., 1965;Haddad, Couranz, and Avioli, 1970;Laitinen, Nikkila, and Kivirikko, 1966;Nakagawa et al., 1967; RuizTorres, 1969;Smiley and Ziff, 1964). Decreased hydroxyproline excretion has been described in hypopituitary and hypothyroid dwarfs (Chiumello and Del