Table 3.

Side effects, specific considerations and limitations for different pharmacologic provocative GH tests

Test	Side Effects	Special Considerations	Limitations
ITT	• hypoglycemia	• secretagogue administered as IV bolus or subcutaneous injection  • must monitor blood glucoses closely and have IV dextrose readily available should severe hypoglycemia develop  • requires physician availability in case the need for resuscitation arises	• generally contraindicated in children <2 years of age or with a history of seizures
Arginine	• facial flushing during infusion  • nausea and vomiting	• secretagogue administered as 30-minute infusion  • extravasation of the arginine infusion burns tissues so IV placement should be verified before starting the infusion
Glucagon	• nausea and vomiting  • late hypoglycemia  • fatigue  • headache	• secretagogue administered as intramuscular or subcutaneous injection  • provokes rise in cortisol  • can be conducted during assessment for hyperinsulinism at the end of a fasting study [103]	• long testing duration of 3–4 hours  • often used in children <2 years of age instead of insulin given relatively safer profile
Levodopa	• nausea and vomiting  • headache  • fatigue  • vertigo	• secretagogue administered as oral medication	• may not be readily available in pediatric centers
Clonidine	• hypotension  • somnolence	• secretagogue administered as oral medication  • test is performed with patient lying recumbent  • vitals are monitored closely throughout the test  • normal saline should be available for infusion to support blood pressure if it drops	• may not be safe in children with some cardiac conditions
GHRH	• flushing	• secretagogue administered as infusion over 1 minute	• cannot detect hypothalamic GHD