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( ARTG ) For the long-term treatment of growth failure in children and adolescents from 2 to 18 years with severe primary insulin-like growth factor 1 deficiency (Primary IGFD).,Severe Primary IGFD is defined by:, height standard deviation score less‍​‍‍‍​‍‍‍‍‍‍‍‍​‍ than or equal to 3.0 and, Baseline height velocity less than the 25th percentile for bone age, based on two measurements over 12 months and, basal IGF-1 levels below the 2.5th percentile for age and gender and, GH sufficiency., Exclusion of secondary forms of IGF-1 deficiency, such as malnutrition, hypopituitarism, hypothyroidism, or chronic treatment with pharmacologic doses of anti-inflammatory steroids.,IGF-1 and GH levels must be performed using validated assays with paediatric normal ranges.