GH deficiency (GHD) may result from dysfunction at different levels:
1. Higher brain centers: neurotransmitter defects a. Lack of stimulators b. Excess of inhibitors
2. Hypothalamus: neuropeptide defects a. Lack of GHRH and/or theoretical endogenous ligand for GHRPs b. Excess of somatostatin
3. Somatotroph a. Lack of synthesis of GH
b. Secretion of bioinactive GH
4. Receptors a. Defects in GH receptors b. Defects in GHRH receptors c. Defects in neurotransmitter receptors
A classification of causes of GHD deficiency and GH resistance is shown in (Table 1).
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