Pediatric Endocrinology Expert Forum
GH testing questions-9 yo boy
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Questions in the Pediatric Endocrinology forum are answered by Dr. Deanna L Aftab Guy. Topics covered include adrenal problems, diabetes insipidus, menstrual irregularities, obesity, parathyroid abnormalities, pituitary abnormalities, puberty concerns, rapid growth, rickets and bone disease, short stature, and thyroid.

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GH testing questions-9 yo boy

We have had our son, age 9, tested for GH (blood tests only) with a stim test now scheduled as blood levels have been low on 2 occassions, bone age was reported at age 6. My son also has selective IgA deficiency, a unilateral hearing loss and has had some severe reactions to vaccination.  In reading information regarding the stimulation test, and also researching other options, I am wondering if the stim test is actually necessary to confirm the need for GH treatment-or if MRI for example could be as effective.  My current endocrinologist said that in some cases she may not recommend the test, but that insurance will not cover the costs of treatment without it.  Yet in my son's case, he has had some severe responses to certain items and I am concerned that he will also have problems with the testing.  Any thoughts from your end?  
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Although it is not the most perfect test, YES the gh stim test is necessary, for many reasons, the lamest reason is for insurance, no company will approve gh without stim test results, the most important medical reason is that the stim test gives us other information, I tend to use insulin and arginine (two tests), the insulin brings sugar down a little and we measure gh levels which should come up, I also measure cortisol which also should come up, if the child has poor gh response AND low cortisol it lets me know we may have more than one hormone lacking, your endocrinologist is right, sometimes we wish we did not need to do the test cause we just know who needs treatment and who may not, we follow our kids pretty closely and have to jump through alot of hoops to get treatment going but you do need testing to get it approved in almost every case, cases that do not need testing include Turner Syndrome and Noonan Syndrome both fda approved indications for gh not necessarily gh deficient states, even my kids who are small for gestational age(another fda indicated diagnosis for gh) need testing to rule out gh deficiency as well as the fact that they were sga.
He should not have problems with the testing if he has it done with a specialized team which it sounds like you have. Also be sure he is tested for celiac, the trouble is that he has igA def and this level is important to validly look at celiac antibodies. Your ped endo is in control, talk with her!
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