6815 Side Effects of Clonidine and Glucagon for Growth Hormone Stimulation Tests and Association with the Level of the Growth Hormone Peak
Authors: Ayala Castro Lina Maria , Ye Tay Joselyn , Solano Natalia , Figueroa Natalia , Geoffrey Andrew , Carrillo-Iregui Adriana , Diaz Alejandro 
Published: October 2024

Disclosure: L.M. Ayala Castro: None. J. Ye Tay: None. N. Solano: None. N. Figueroa: None. A. Geoffrey: None. A. Carrillo-Iregui: None. A. Diaz: None.

Background: Growth Hormone (GH) stimulation tests play a crucial role in diagnosing growth hormone deficiency among pediatric patients. Various agents are employed to stimulate growth hormone production, with diagnostic criteria often relying on identifying low growth hormone levels post-administration of two distinct agents. Over the last 15 years, our practice has employed clonidine and glucagon combined testing, 90 minutes apart, with samples for growth hormone every 30 minutes. As such, we eliminate the need for infusion when using arginine. Objective: This study aims to evaluate the incidence of side effects from clonidine and glucagon and to explore any potential correlation with peak GH levels. Methods: In this retrospective cohort study, we analyzed 98 pediatric patients aged 4 to 17 years who underwent Clonidine/Glucagon growth hormone testing between January 2023, and September 2023, at a tertiary care center. Patients were categorized into three groups based on their peak GH levels: less than 5 ng/mL, 5 to 10 ng/mL, and more than 10 ng/mL. The total incidence of hypotension and nausea/vomiting and its relation to peak GH levels were collected. Chi-squared tests for independence were employed to assess statistical significance. Of note, hypotension was defined as mean arterial pressure (MAP) calculations falling below 60 mmHg or exhibiting symptomatic indications. The healthcare information platform utilized was Cerner, which provides age-appropriate blood pressure (BP) ranges and alerts nurses in case of a significant deviation from the baseline reading. Results: Among the 98 patients, 38 (38.8%) experienced hypotension, while 8 (8.2%) reported nausea and/or vomiting. An association was found between hypotension and higher GH peaks, with 23.7% (9/38) in patients with GH peak less than 5 ng/mL, 42.5% (17/41) between 5 and 10 ng/mL, and 57.1% (12/19) over 10 ng/mL. Vomiting and/or nausea occurred in 15.8% (6/38) with GH peak less than 5 ng/mL, 5% (2/41) between 5 and 10 ng/mL, and 0% (0/19) among patients with a GH peak over 10 ng/mL. Chi-squared tests indicated a significant association with hypotension (p = 0.0141) but not with vomiting/nausea (p = 0.0733) at a 0.05 alpha level. None of the patients required extended stays or admission due to side effects; all of them improved with a bolus of IV fluids. Conclusion: Hypotension emerges as a relatively common side effect of clonidine in the GH stimulation test. Our study revealed a significant association between higher GH peak levels and the occurrence of hypotension. Conversely, nausea and vomiting, typically linked to glucagon injection, were infrequent, and we observed no correlation with GH peak levels. The combination of clonidine and glucagon stands out as an effective approach for assessing GH production, eliminating the need for infusions, and demonstrating a good safety profile.

Presentation: 6/3/2024