The purpose of this study was to evaluate the clinical application of serum insulin-like growth factor-I (IGF-I) levels for the workup of prepubertal children with short stature. IGF-I serum levels were measured by radioimmunoassay in 92 short prepubertal children (55 normal-short children, 18 dysmorphic-short children, and 19 children with classical growth hormone deficiency) and 105 normal prepubertal children. The serum IGF-I levels (mean +/- SEM) in these three groups of short children were 160 +/- 9 ng/ml, 188 +/- 16 ng/ml and 26 +/- 3 ng/ml, respectively. The mean serum IGF-I level for the 105 normal prepubertal children was 160 +/- 7 ng/ml. The mean serum IGF-I levels of the first two groups of short children were not significantly different from that of the prepubertal children with normal stature. On the other hand, the mean serum IGF-I level in children with classical growth hormone deficiency was significantly lower than those of the other two groups of short children and that of prepubertal children with normal stature. Our study shows that the determination of serum IGF-I levels is of clinical value in the evaluation of short prepubertal children.