Short stature.

Consistent abnormally low growth velocity.

Assessment of possible growth hormone deficiency.

Where the ITT is not recommended or not suitable.

1. Patient to have water only for 8 hours prior to the test.
2. Arginine may cause nausea and some irritation at the infusion site. A cannula of at least 22g should be used.
3. In children with suspected hypopituitarism prolonged fasting may induce hypoglycaemia. Blood glucose should be checked by ward meter with each sample in these patients whenever a sample is taken.
4. This test can be combined with synacthen test to assess adrenal cortisol production (but not ACTH deficiency), in addition to growth hormone deficiency.

Drug(s) Given

Arginine monochloride 0.5g/kg
Up to a maximum of 30g.

How Given

Dilute Arginine in equal quantities of 0.9% saline and infuse over 30 minutes.

For example, dose 0.5gms per kilo
20kg child = 10gms of arginine= 20mls of arginine solution (5gms in 10mls).

Add 20mls of arginine solution to 20mls of 0.9% saline.

Timing of Administration

Give after the first basal blood sample has been taken and the Capillary Blood Glucose is known.

	Time (minutes)
	-30	0	15	30	60	95	120
Glucose
GH
Cortisol 1
IGF1
T4, TSH

1 If synacthen test is performed at the same time.

If the plasma GH concentration reaches 6.7 micrograms/L or more, further investigations are not indicated.

If the response is below this level, then an insulin hypoglycaemia test may be necessary.