Dr Pinhas-Hamiel: In the clinical context of short stature and headaches, the possibility of central nervous system involvement should be considered. I generally do not perform incidental growth hormone measurements, as the secretion of growth hormone is episodic, and random blood samples are frequently not informative. When growth velocity is abnormal, I prefer provocative stimulation tests. Nevertheless, the normal growth hormone level in this case rules out growth hormone deficiency. The contribution of skull radiographic evidence is limited, and, currently, when there is a clinical suggestion, other brain imaging studies are performed. With a normal serum level of growth hormone, no evidence of central nervous system insult, and a normal karyotype, the major possible diagnoses have been excluded. I would have the child undergo yearly height measurement by the pediatrician to affirm that she is growing consistently and to reassure the family.