Evaluation is a multi step process and starts with your primary care physician

See your primary care physician when you suspect your child is not growing well

Primary care evaluation

Primary care Growth evaluation process
1. How to use Growth charts: use and interpretation
2. Growth Charts in English and Spanish
3. Bone age X ray - please hand carry for your pediatric endocrinologist appointment

Pediatric endocrine evaluation

  • History
  • Physical exam including pubertal evaluation
  • Planning initial set of labs including IGF-1.
What is IGF-1: IGF-1 levels can be measured in the blood in 10-1000 ng/ml amounts. As levels do not fluctuate greatly throughout the day for an individual person, IGF-1 is used by physicians as a screening test for growth hormone deficiency 
Interpretation of IGF-1 levels is complicated by the wide normal ranges, and marked variations by age, sex, and pubertal stage. Clinically significant conditions and changes may be masked by the wide normal ranges. Sequential management over time is often useful for the management of several types of pituitary disease, undernutrition, and growth problems.

FOllow up appointment with PEDiatric endocrinologist

We will see you in the office few weeks after the appointment. During that appointment we will interpret the Growth hormone stimulation test results and future management which may include MRI of the pituitary gland and starting the process of getting an approval for growth hormone therapy.

​Normal results include:
  • Normal peak value, at least 10 ng/mL (10 µg/L)
  • Indeterminate, 5 to 10 ng/mL (5 to 10 µg/L)
  • Subnormal, 5 ng/mL (5 µg/L)
A normal value rules out hGH deficiency. In some laboratories, the normal level is 7 ng/mL (7 µg/L).
Normal value ranges may vary slightly among different laboratories. Some labs use different measurements or test different samples. Talk to your provider about the meaning of your specific test results.

Growth hormone Stimulation test

It is done at the Sutter outpatient testing center at Sutter Medical Center, Sacramento, CA
​A growth hormone stimulation test is done to find out if the pituitary gland is releasing growth hormone (GH) in the right amounts. The pituitary is a small gland (about the size of a pea) in the brain. It releases hormones that affect growth into the bloodstream. Medicine will be used to stimulate the pituitary gland to release growth hormone into the blood.
The medicines used with your child are L-arginine (EL AR jah neen) and:
  • L- Dopa ( Sinemet)
  • Rarely Glucagon (GLU ka gon)
Samples of blood are then taken and sent to the laboratory. In the lab, the growth hormone levels in the blood are measured.

The Night Before the Test
  • At the time of the test, your child should be free of any illness.
  • Your child should have nothing to eat or drink after midnight the night before the test, except tap water. This means NO breakfast, breath mints, chewing gum, flavored or bottled water.
  • Your child should not take any medicine before the test unless your doctor tells you the medicine may be given. You may bring the medicine with you to the test so it may be given when the test is finished.
  • Your child should go to bed at the usual time.
  • Be sure to tell the doctor if your child has any allergies or reactions to medicine, food preservatives or dyes. Tell the doctor about the allergy and its effects on your child. Effects include rash, hives, itching, shortness of breath, wheezing, coughing, swelling of face, lips, tongue or throat or any other symptoms involved.
  • Be sure to tell the doctor if your child has recently or is currently taking steroids.
The Day of the Test
  • Your child should feel well and not have a fever the day of the test.
  • He or she should come to the clinic dressed comfortably. It would be best if your child wears a short-sleeved shirt to the test.
  • Bring books, toys or games for your child to use during the test. Sutter outpatient center also has video games and other things to make your child comfortable.
How the Test is Done:
The test will be done in the Infusion Clinic. This test may take up to 6 hours. Parents are asked to stay with their child during the test. Since we have limited seating, family members other than 2 parents may be asked to sit in the waiting room during the test.
  • The nurse will start an IV (intravenous line). The nurse may offer to put lidocaine prilocaine cream on your child’s arm before starting an IV. The cream will start to work about 20 minutes after it is put on. It is used to decrease the pain from starting IV’s.
  • A sample of blood will be drawn from the IV. The IV will be used to draw blood samples and to give the L-Arginine
  • Sinemet is a pill that is taken by mouth. Glucagon is another medicine, given by injection just under the skin in the upper arm. Your child’s doctor will choose which medicines to use for the test.
  • Blood samples will be drawn for growth hormone studies every 30 minutes for up to 4 hours. Your child should not feel any discomfort when blood is drawn, since it will be drawn from the existing IV. The total amount of blood is small (about 5 teaspoons).
After the Test:
When the test is over, your child may have his or her regular foods. Feel free to bring a snack with you for your child to eat after the test.
  • Have your child drink plenty of liquids the rest of the day.
  • Your child's doctor will contact you about the test results and plan for medical care
Side Effects of Medicines
  • L dopa: May have some nausea, rarely vomiting and it self corrects.
  • L-Arginine: This medicine can cause low blood sugar, which can also make your child lightheaded or nauseated. Side effects from L-Arginine are rare and usually pass by the time your child goes home.
  • Glucagon: This medicine can also cause low blood sugar, which can lead to nausea and vomiting. After the test has been completed, a snack or meal will help to make your child feel better.