title: Testing for growth hormone deficiency in adults:  doing without growth hormone-releasing hormone.
abstract: OBJECTIVE
  This article summarizes recent advances in testing for growth hormone deficiency (GHD) in adults, focusing on critical appraisal of existing growth hormone (GH) provocative tests as well as newer tests in development.
  
  
  RESULTS
  The diagnosis of GHD can be challenging and often requires the use of GH provocative testing. The most widely validated of these is insulin-induced hypoglycemia (ITT), which requires close supervision and has significant contraindications and side-effects. The arginine-growth hormone-releasing hormone (GHRH) test had become widely used as a safe and accurate alternative to the ITT, but GHRH is currently unavailable for clinical use in the USA. On the basis of review of recent literature we recommend that in the absence of GHRH, glucagon stimulation testing should be the preferred alternative to ITT. Several synthetic GH secretagogues that mimic the gastric peptide ghrelin are currently in development and may become available for use in the diagnosis of GHD in the near future. Other GH provocative tests suitable for use in children lack adequate specificity for the diagnosis of GHD in adults.
  
  
  CONCLUSIONS
  Due to the current unavailability of the arginine-GHRH test in the USA, when ITT is contraindicated or impractical we recommend the glucagon stimulation testing as the GH provocative test of choice. There remains a need for a simple, safe and accurate test for the diagnosis of GHD.
authors.affiliation: Division of Endocrinology, Diabetes, and Metabolism, University of Miami Miller School of Medicine, Miami, Florida, USA.
authors.forename: Atil Y
authors.initials: AY
authors.lastname: Kargi
authors.forename: George R
authors.initials: GR
authors.lastname: Merriam
mesh_terms: D000328:Adult; D001120:Arginine / Q000097:blood*; D005260:Female; D013007:Growth Hormone-Releasing Hormone / Q000097:blood* / Q000172:deficiency; D017408:Guidelines as Topic; D006801:Humans; D007003:Hypoglycemia / Q000097:blood* / Q000139:chemically induced / Q000503:physiopathology; D007018:Hypopituitarism / Q000097:blood* / Q000175:diagnosis; D007328:Insulin / Q000097:blood*; D007334:Insulin-Like Growth Factor I / Q000378:metabolism*; D008297:Male; D018579:Patient Selection; D014481:United States
chemical_list: D007328:Insulin; D007334:Insulin-Like Growth Factor I; D013007:Growth Hormone-Releasing Hormone; D001120:Arginine