Growth Hormone Stimulation Testing Protocol

Overview

Growth hormone (GH) stimulation testing is essential for diagnosing GH deficiency in children and adults. This protocol outlines the standard procedure for conducting GH stimulation tests.

Indications

• Short stature in children
• Growth velocity decline
• Suspected GH deficiency
• Adult GH deficiency evaluation

Pre-Test Requirements

Patient Preparation

• Fasting for 8-12 hours
• Morning appointment (before 10 AM)
• Discontinue interfering medications (consult formulary)
• IV access established

Required Materials

• Stimulating agent (choose one):
  • Glucagon
  • Arginine
  • Clonidine
  • GHRH
  • Insulin
• Blood collection tubes
• IV supplies
• Emergency kit

Testing Procedure

1. Baseline Measurements

• Obtain baseline GH and glucose levels
• Record vital signs
• Document height and weight

2. Stimulation Phase

Administer chosen stimulating agent:

Glucagon Protocol:

• Adults: 1mg IM
• Children: 0.03mg/kg (max 1mg) IM

Insulin Protocol:

• 0.05-0.1 units/kg IV
• Monitor glucose closely

3. Sample Collection

Obtain samples at:

• 0 min (baseline)
• 30 min
• 60 min
• 90 min
• 120 min
• 180 min (if required)

Result Interpretation

Normal Values

• Children: Peak GH >10 ng/mL
• Adults: Peak GH >3 ng/mL

Failed Test Criteria

• Peak GH below cutoff values
• Consider repeat testing with different stimulus

Safety Considerations

• Monitor vital signs throughout
• Have D50W available for insulin testing
• Document adverse reactions
• Maintain emergency protocols

Documentation Requirements

1. Test timing and dosing
2. All GH and glucose values
3. Adverse events
4. Patient response
5. Final interpretation