Which provocative tests are performed in the evaluation of short stature?

Updated: Jan 06, 2021
  • Author: Sunil Kumar Sinha, MD; Chief Editor: Robert P Hoffman, MD  more...
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Answer

Several provocative tests have been developed for the evaluation of suspected GHD, including the following:

  • Insulin-induced hypoglycemia is the most powerful stimulus for GH secretion; however, this test also carries the greatest potential for harm and is the only GH provocative test that has been associated with fatalities.

  • Alternate GH secretagogues used successfully in combination as 2 serial tests include arginine, levodopa, propranolol with glucagon, exercise, clonidine, or epinephrine.

  • Peak GH level is higher if the patient has been recently exposed to sex steroids, but controversy among pediatric endocrinologists persists regarding the use of sex steroid priming prior to stimulation testing.

Perform all GH provocative testing under the supervision of a pediatric endocrinologist. Please refer to Hyposomatotropism for further details of these tests.


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