Review Reports

Round 1

Reviewer 1 Report

This manuscript is concise and very well organized. 

It will help readers understand the disease of growth hormone deficiency. 

Author Response

Thank you for the comments and suggestions. 

Reviewer 2 Report

Please refer to comments below. Needs some minor edits. Article can be more exhaustive.

Comments for author File: Comments.docx

Author Response

Thank you for taking the time to review the manuscript and for your feedback.  Several changes were made to the manuscript as per your comments and suggestions. 

Reviewer 3 Report

It's a review manuscript that addresses all the relevant aspects in relation to GHD

- I would suggest to cite the paper: Provocative growth hormone testing in children: how did we get here and where do we go now? from Kamoun et al, with some very interesting issues about GH stimulation tests and GH cut off

- I also suggest at least one paragraph about false positives and negatives of stimulation tests

- check line 188: "and are therefore are combined"

Author Response

Thank you for taking the time to review the manuscript and for your feedback.  Changes were made as per your comments and suggestions.  

Reviewer 4 Report

this is another comprehensive review about growth hormone deficiency, well written and well structured.

my mayor point is about the selection of citations, especially concerning the value of GH stimulation tests and the cut-off levels used.

1.--all the consensus guidelines of international societies should be cited at the appropriate places TOGETHER, not distributed across the manuspcript (2000 guidline concerning cutoff, 2016 consensus Grinberg et al concerning dosage ect)

2.--cutoff 10 ng/ml is too superficial- please cite 2000 consensus (33) and Grimberg et al (47) and mention that Richmont has already reviewed the reason for lower cut offs (45). Consider to cite Wagner et al EJE 2014,Müller et al Clin Chem Lab med 2011, Binder et al GH & IGF Res (2011) with respect to cut-offs in the respective chapter

3. Line 181: Gh testing has limitations but is still the gold standard- please start with consensus recommendations to perform 2 tests and then give the exceptions , like the consensus statements define them

Author Response

Thank you for taking the time to review the manuscript and for your feedback.  There was also feedback by other reviewers re GH stim testing, I revised that section taking into account everyone's comments and suggestions.