What is the role of radiography in the workup of hyposomatotropism (growth hormone deficiency [GHD])?

Updated: Jan 24, 2019
  • Author: Sunil Kumar Sinha, MD; Chief Editor: Robert P Hoffman, MD  more...
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Radiography to assess skeletal maturation, similar to an examination of growth and development, is a useful diagnostic tool to determine a patient's GH secretory status. Anteroposterior radiographs of the left hand and wrist (knee or ankle in children < 1 yr) are used to evaluate the progress of epiphyseal ossification by comparing the results to age-matched and sex-matched reference ranges.

Crude estimates of skeletal maturation can also be obtained by assessing dental eruption. Primary teeth begin to erupt at approximately 6 months of age, and exfoliation starts at 6-12 years.

Height predictions rely on the observation that the greater the delay in bone age relative to chronologic age, the longer the time before epiphyseal fusion occurs and, thus, final height is achieved. The method of height prediction is based on formulas Bayley and Pinneau developed using information from Greulich and Pyle's classic radiographic atlas. [45] Tanner and colleagues and Roche and colleagues subsequently refined these predictions by linking skeletal maturation to a rating of sexual maturity. [59, 46]

Each system is useful for estimating the range of a patient's likely adult height to within 2 inches above or below the predicted value. A major limitation of current methods for predicting height is that the standards Greulich and Pyle established are based on calculations from a few Caucasian children who lived in 2 affluent suburbs in the United States during the 1940s. Normal skeletal maturation varies with ethnicity and is likely to vary with socioeconomic status. Moreover, most industrialized countries are home to a heterogeneous population. A modern reappraisal of these radiographic standards is overdue.

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