Clearly, there is no ideal stimulation test and we recommend that the decision to embark on a stimulation test, to diagnose adult GHD must factor in the appropriate clinical context of each individual patient together with the number of pituitary hormone deficiencies plus serum IGF-I level [10], the validity of the chosen test and its appropriate cutoff limits, the sensitivity of the GH assay, and the availability of local resources and expertise. This evidence concerns the gene IGF1 and hypopituitarism.