About 1/3 of the causes of short stature are due to growth hormone deficiency. For short stature due to growth hormone deficiency, an important test to assess the presence of growth hormone deficiency is the growth hormone stimulation test. However, the growth hormone provocation test is not the gold standard for the diagnosis of growth hormone deficiency dwarfism because, firstly, the test has false positives and at least two provocation tests must be performed to resolve this problem. Secondly, the secretion of growth hormone is also affected by sex hormones, thyroid hormones, blood glucose, obesity and other factors. Even if both stimulation tests indicate growth hormone deficiency, it is not certain that growth hormone deficiency is the cause of dwarfism. The two most common clinical causes of short stature are growth hormone deficiency and delayed somatic puberty. We cannot rely solely on growth hormone stimulation tests to differentiate between the two. In some patients with delayed puberty, because the pulsatile secretion pattern of gonadotropins has not been established, and the level of sex hormones is low at this time, and the increase of sex hormone secretion is the initiating factor for the secretion of a large amount of growth hormone during puberty, therefore, in the case of sex hormone deficiency, there can be a variety of growth hormone excitation test results that cannot be excited. At this point, the identification focuses first on family history, for children with somatic delayed puberty, where both or one parent has a history of delayed puberty. Secondly, the focus is on dynamic observation of the child’s annual height growth rate. In children with true growth hormone deficiency, the annual height growth rate is often less than 4 cm, and short stature is evident. However, family history and annual growth rate are often not provided correctly due to parental carelessness and forgetfulness, which makes the diagnosis of some children difficult. Of course, the diagnosis can be clarified at this time through follow-up observation. However, as one parent often has high expectations, failure to give growth hormone treatment may result in missing the best time for treatment for those children with true growth hormone deficiency. Therefore, about 10% of children may be misdiagnosed as growth hormone deficient dwarf and given growth hormone treatment. Clinically, for this group of children, we recommend performing a growth hormone excitation test again after the initiation of puberty to achieve a clear diagnosis and discontinue growth hormone early.