Hematuria as an adverse outcome following provocative growth hormone stimulation testing in children

Abstract

Provocative growth hormone (GH) stimulation testing is used to evaluate short stature and growth failure in children. Agents commonly used for testing include clonidine, arginine and glucagon. While stimulation testing is generally considered safe, gross hematuria has been described as a rare idiopathic complication of GH stimulation testing. This study was designed to estimate the incidence of both microscopic and macroscopic hematuria following GH testing with different provocative agents. Subjects undergoing GH stimulation testing were invited to participate in the study. Prior to testing, vital signs were measured and baseline point-of-care (POC) urinalysis was done. The subjects performed urine testing at home on days 1, 2, 3 and 7 following GH stimulation studies. Families notified the study team with any positive findings and returned the data collection tool by mail. In total, 34 subjects aged 11.14±2.71 years (91.2% male) completed the study. Agents used in provocative testing included arginine (73.5%), clonidine (94.1%) and glucagon (32.4%). Three subjects developed hematuria after GH stimulation testing (clonidine/arginine). The hematuria resolved by 7 days after testing. Additional adverse effects included nausea, vomiting and hypotension. In this study of children undergoing GH testing, hematuria was identified in three subjects. This study demonstrates that side effects to agents used for GH testing are self-limited, yet not rare, and should be discussed with patients and families prior to stimulation testing.