Sleep assessment

Blood pressure monitoring

■ r "id : ÏD^r^lo- (.:'" ■: did artery children in whom GH deficiency is suspected. Numerous pharmacologic agents such as insulin-induced hypoglycemia, levodopa, arginine, arginine plus levodopa, argin-ine plus GHRH, clonidine, and glucagon have been used to stimulate the pituitary to produce GH. However, no single test perfectly predicts GH deficiency or displays 100% sensitivity and specificity. 3 Additionally, administration of each of these tests is associated with adverse effects requiring close medical supervision. Further, current abnormal cutoffs to determine diagnosis are arbitrarily defined and lack universal con-

32 33

sensus. ' With further studies, these diagnostic criteria are likely to evolve and become more accurate. In prepubertal children, measurement of IGF-I concentrations may be useful in evaluating GH deficiency, with 100% specificity and 70% to 90% sensitivity.34 In children, the diagnosis of GH deficiency is further supported if height is more than two standard deviations below the population mean (age- and sex-

matched). Failure of linear growth is an almost universal presenting feature of childhood GH deficiency.

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