Hypopituitarism is a complete or partial insufficiency of pituitary hormone secretion that may derive from hypothalamic or pituitary disease. The onset can be at any time of life. Hypopituitarism in childhood may have either a congenital or an acquired basis. Disorders involving the growth hormone pathway result in deficiency or ineffectiveness of insulin like growth factor-I (IGF-1). Congenital growth hormone deficiency is associated with structural malformations of the central nervous system, hypothalamus, or pituitary. Genetic defects involving critical factors in the embryological development of the pituitary or in the cascade from hypothalarnic stimulation of growth hormone release to completion of IGF effect on growth may result in IGF-I deficiency/resistance. Acquired abnormalties affecting the growth hormone/IGF axis range from damage to the hypothalamic pituitary region from tumors, autoimmune disease, infections or radiation to a broad spectrum of chronic conditions characterized by catabolism. A head MRI scan is critical in attempting to determine the specific cause in either case. Identified hormone abnormalities require treatment with appropriate hormonal replacement therapies, including GH, usually for life. All children with hypopituitarism require supervision of medical care by a pediatric endocrinologist and, when older, appropriate transition to an internist endocrinologist or to a reproductive endocrinologist.