Validation of Two Measures for Growth Hormone Deficiency in Children, the Treatment Related Impact Measure of Childhood Growth Hormone Deficiency (TRIM-CGHD) and the Treatment Burden Measure of Childhood Growth Hormone Deficiency (TB-CGHD)

Inclusion Criteria:

- Informed consent obtained

- Child population - treatment näive:

- Confirmed diagnosis of Growth Hormone Deficiency (GHD) prior to enrolment as
determined by a Growth Hormone (GH) stimulation test, defined as a peak GH level of
7.0 ng/ml or less. The GH stimulation test will be according to local clinical
standards

- Pre pubertal children age 9 to less than 13 years at enrolment

- No prior exposure to GH therapy (GH-treatment naïve)

- Annualized height velocity (HV) below the 25th percentile for Chronological Age (CA)
(HV less than -0.7 SD scores) and sex according to the standards of Prader et al
(1989)

- Body Mass Index (BMI) percentile greater than 5th and below 95th percentile according
to Centers for Disease Control and Prevention (CDC) BMI-for-age growth charts

- Child population - maintenance patients:

- Confirmed diagnosis of GHD prior to enrolment as determined by a GH stimulation test,
defined as a peak GH level of 10.0 ng/ml or less. The GH stimulation test will be
according to local clinical standards

- Pre pubertal children age 9 to less than 13 years at enrolment

- Body Mass Index (BMI) percentile greater than 5th and below 95th percentile according
to Centers for Disease Control and Prevention (CDC) BMI-for-age growth charts

- Parent/Guardian population - treatment näive:

- Parent/Guardian of child with a confirmed diagnosis of GHD prior to enrolment as
determined by a GH stimulation test, defined as a peak GH level of 7.0 ng/ml or less.
The GH stimulation test will be according to local clinical standards

- Parent/Guardian of pre pubertal child age 4 to less than 9 years at enrolment

- Parent/Guardian of child with no prior exposure to GH therapy (GH-treatment naïve)

- Parent/Guardian of child with annualized height velocity (HV) below the 25th
percentile for CA (HV less than -0.7 SD scores) and sex according to the standards of
Prader et al (1989)

- Parent/Guardian of child with Body Mass Index (BMI) percentile greater than 5th and
below 95th percentile according to Centers for Disease Control and Prevention (CDC)
BMI-for-age growth charts

- Parent/Guardian living in the same residence as the child at least 50% of the time

- Parent/Guardian population - maintenance patients:

- Parent/Guardian of child with confirmed diagnosis of GHD prior to enrolment as
determined by a GH stimulation test, defined as a peak GH level of 10.0 ng/ml or less.
The GH stimulation test will be according to local clinical standards

- Parent/Guardian of pre pubertal child age 4 to less than 9 years at enrolment

- Parent/Guardian of child with Body Mass Index (BMI) percentile greater than 5th and
below 95th percentile according to Centers for Disease Control and Prevention (CDC)
BMI-for-age growth charts

- Parent/Guardian living in the same residence as the child at least 50% of the time
Exclusion Criteria:

- Child population - treatment näive and maintenance patients:

- Any clinically significant abnormality likely to affect growth or the ability to
evaluate growth:

- a) Chromosomal abnormalities and medical "syndromes", e.g. but not limited to Turner's
syndrome, Laron syndrome, Noonan syndrome, or absence of GH receptors

- b) Congenital abnormalities (causing skeletal abnormalities), e.g. but not limited to
Russell-Silver Syndrome, skeletal dysplasia's

- c) Significant spinal abnormalities including scoliosis, kyphosis and spina bifida
variants - Children born small for gestational age (SGA - birth weight and/or birth
length less than -2 SD for gestational age)

- Children diagnosed with diabetes mellitus or fasting blood glucose greater than or
equal to 126 mg/dl (7.0 mmol/L), or HbA1c greater than or equal to 6.5% at enrolment

- Current inflammatory diseases (e.g. but not limited to arthritis, inflammatory bowel
diseases) requiring systemic corticosteroid treatment or glucocorticoids treatment for
longer than 2 weeks within the last 3 months prior to enrolment

- Children requiring glucocorticoid therapy (e.g. asthma) who are taking a dose of
greater than 400 µg/day of inhaled budesonide or equivalents for longer than 1 month
the year prior to enrolment

- Concomitant administration of other treatments that may have an effect on growth, e.g.
but not limited to anabolic steroids and methylphenidate for attention deficit
hyperactivity disorder (ADHD). Hormone replacement therapies (thyroxin,
hydrocortisone, desmopressin) are allowed for inclusion

- Any disorder which, in the opinion of the investigator, might jeopardise subject's
safety or compliance with the protocol

- The subject and/or the parent/Legally Acceptable Representative (LAR) are likely to be
non-compliant in respect to trial conduct, as judged by the investigator

- Parent/Guardian population - treatment näive and maintenance patients:

- Parent/Guardian of child with any clinically significant abnormality likely to affect
growth or the ability to evaluate growth:

- a) Chromosomal abnormalities and medical "syndromes", e.g. but not limited to Turner's
syndrome, Laron syndrome, Noonan syndrome, or absence of GH receptors

- b) Congenital abnormalities (causing skeletal abnormalities), e.g. but not limited to
Russell-Silver Syndrome, skeletal dysplasia's

- c) Significant spinal abnormalities including scoliosis, kyphosis and spina bifida
variants - Parent/Guardian of child born small for gestational age (SGA - birth weight
and/or birth length less than -2 SD for gestational age)

- Parent/Guardian of child diagnosed with diabetes mellitus or fasting blood glucose
greater than or equal to 126 mg/dl (7.0 mmol/L), or HbA1c greater than or equal to
6.5% at enrolment

- Parent/Guardian of child with current inflammatory diseases (e.g. but not limited to
arthritis, inflammatory bowel diseases) requiring systemic corticosteroid treatment or
glucocorticoids treatment for longer than 2 weeks within the last 3 months prior to
enrolment

- Parent/Guardian of children requiring glucocorticoid therapy (e.g. asthma) who are
taking a dose of greater than 400 µg/day of inhaled budesonide or equivalents for
longer than 1 month the year prior to enrolment

- Parent/Guardian of child with concomitant administration of other treatments that may
have an effect on growth, e.g. but not limited to anabolic steroids and
methylphenidate for attention deficit hyperactivity disorder (ADHD). Hormone
replacement therapies (thyroxin, hydrocortisone, desmopressin) are allowed for
inclusion

- Parent/Guardian of child with any disorder which, in the opinion of the investigator,
might jeopardise subject's safety or compliance with the protocol

- The subject and/or the parent/LAR are likely to be non-compliant in respect to trial
conduct, as judged by the investigator