Abdus Sattar, Tariq Mahmood Awan, Mirza Muhammad Dawood, Ehsan Gul Khattak, Zahur Ur Rehman.
Strategies for cost effective use of dynamic function tests to evaluate growth Hormone (GH) deficiency..
Pak J Pathol Jan ;11(4):7-10.

Two hundred and seventy three children of short stature were evaluated for growth hormone (GH) deficiency. Screening was carried out by exercise stimulation test and/or L-dopa stimulation test. Basal and post stimulation blood specimens were assayed for GH level. GH deficiency was found in 66 children. Out of these, 54 patients were subjected to Insulin Tolerance Test (ITT) for confirmation of GH deficiency. During ITT four blood samples for GH were obtained; prior to stimulation (basal), at the time of induction of hypoglycemia, at 30 minutes and at 60 minutes post induction. The results were critically analyzed for cost effectiveness. The results revealed no significant difference between basal GH levels of normal and GH deficient children on screening tests. During ITT, peak GH response was seen either at the time of induction of hypoglycemia or at 30 minutes after induction. It was therefore, concluded that basal sample during ITT could be omitted because it has already been taken at the time of screening. Moreover, during ITT, 60 minutes post induction sample could be omitted to make the test more cost effective and convenient for the patient.

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