A deficiency of growth hormone secretion before puberty (by the end of which the synthesis of new bone tissue is complete) results in pituitary dwarfism. Pituitary dwarfs, who can be as little as 3 to 4 ft (91–122 cm) tall, are generally well proportioned except for the head, which may be relatively large when compared to the body (this relationship of head to body is similar to that of normal children). Unlike cretins, whose dwarfism is caused by a deficiency of thyroxine, pituitary dwarfs are not mentally retarded; they are often sexually immature. They can be treated by injections of synthetic growth hormone, either somatrem or somatropin, which are produced by genetically engineered bacteria.
An excess of growth hormone in children results in gigantism; these children grow to be over 7 ft (213 cm) in height and have disproportionately long limbs. Excess growth hormone produced after puberty has little effect on the growth of the skeleton, but it results in a disease affecting terminal skeletal structures known as acromegaly.