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Growth hormone deficiency: craniofacial characteristics and changes after growth hormone therapy - a systematic
Panagiotis Pallis1, Ioannis Padouvas1, Evangelos Theodoros Markos1
1School of Dentistry, National and Kapodistrian University of Athens, 2 Thivon Str, Athens, 11527, Greece.
Background:
Growth hormone deficiency (GHD) is among the most common pituitary hormone disorders in children, causing impaired growth in children and may also affect craniofacial and dental development. Growth hormone therapy (GHT) is the main course of treatment. Despite the high prevalence of GHD, the craniofacial phenotype associated with GHD and the changes observed during therapy have been only partially reviewed in the current literature.
Purpose:
This systematic review aimed to compile evidence from January 2000 to April 2026 regarding the craniofacial features of children and adolescents with non-syndromic GHD, as well as the craniofacial changes observed during GHT.
Methods:
PubMed, Google Scholar and Scopus were searched for studies published from 2000 to April 2026 that assessed craniofacial or dental changes in non-syndromic GHD patients undergoing GHT. Two reviewers screened the studies and assessed risk of bias using the AXIS tool and the Newcastle-Ottawa Scale. Owing to methodological and clinical heterogeneity, a meta-analysis was not performed.
Results:
A total of 621 records were identified; after removing duplicates and applying screening criteria, 10 studies were included. Baseline data generally showed that children with GHD had smaller cranial base and jaw dimensions, retrognathic maxillary and mandibular positions, increased facial convexity, and delayed dental development or eruption compared to healthy peers. Studies on GHT mostly reported craniofacial growth approaching reference values, especially in the maxilla, mandibular ramus, and facial height. Nonetheless, the evidence was limited by small sample sizes, diverse outcome measures, mixed control groups, and generally moderate risk of bias.
Conclusion:
Available observational evidence indicates that non-syndromic GHD is associated with a characteristic pattern of craniofacial underdevelopment and delayed dentofacial maturation, whereas GHT may partially normalize several craniofacial parameters. These findings should be interpreted with caution because all included studies were observational and clinically diverse.