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• W2093669979 abstract "Huang et al1Huang C Banerjee K Sochett E Perlman K Wherrett D Daneman D. Hypoglycemia associated with clonidine testing for growth hormone deficiency.J Pediatr. 2001; 139: 323-324Abstract Full Text Full Text PDF PubMed Scopus (20) Google Scholar report on the detection of hypoglycemia in 4 of 165 children during and/or after clonidine testing. Clonidine is currently one of the most commonly used medications for testing growth hormone (GH) reserve in children with short stature. Clonidine stimulates pituitary GH release through its α2-adrenergic action2Lanes R Hurtado E. Oral clonidine—an effective growth hormone releasing-agent in prepubertal subjects.J Pediatr. 1982; 100: 710-713Abstract Full Text PDF PubMed Scopus (94) Google Scholar, 3Lanes R Recker B Fort P Lifshitz F. Low-dose oral clonidine.Arch Pediatr Adolesc Med. 1985; 139: 87-88Crossref Google Scholar, 4Gil-Ad I Topper E Laron Z. Oral clonidine as a growth hormone stimulation test.Lancet. 1979; 2: 278-280Abstract PubMed Scopus (145) Google Scholar, 5Slover RH Klingensmith G Gotlin RW Radcliffe J. A comparison of clonidine and standard provocative agents of growth hormone.Arch Pediatr Adolesc Med. 1984; 138: 314-317Crossref Scopus (27) Google Scholar and is considered to be more potent than either levodopa and arginine. It is generally considered safe, with drowsiness and an asymptomatic fall in blood pressure as the only commonly encountered side effects. We agree with Huang et al1Huang C Banerjee K Sochett E Perlman K Wherrett D Daneman D. Hypoglycemia associated with clonidine testing for growth hormone deficiency.J Pediatr. 2001; 139: 323-324Abstract Full Text Full Text PDF PubMed Scopus (20) Google Scholar that some children of short stature undergoing clonidine testing after an overnight fast are at risk for hypoglycemia. A subgroup of these children has GH deficiency, which may diminish their ability to increase gluconeogenesis appropriately during prolonged fasting. Some children undergoing testing may have failure to thrive, predisposing them to ketotic hypoglycemia associated with significant substrate deficiency. In addition, the drowsiness induced by clonidine may decrease awareness of hypoglycemic symptoms, leading to a delay in treatment and poor caloric intake by the child after the completion of the test. There is no change in glucose concentrations after clonidine ingestion in children of short stature2Lanes R Hurtado E. Oral clonidine—an effective growth hormone releasing-agent in prepubertal subjects.J Pediatr. 1982; 100: 710-713Abstract Full Text PDF PubMed Scopus (94) Google Scholar, 5Slover RH Klingensmith G Gotlin RW Radcliffe J. A comparison of clonidine and standard provocative agents of growth hormone.Arch Pediatr Adolesc Med. 1984; 138: 314-317Crossref Scopus (27) Google Scholar; there is a significant fall in cortisol concentrations.2Lanes R Hurtado E. Oral clonidine—an effective growth hormone releasing-agent in prepubertal subjects.J Pediatr. 1982; 100: 710-713Abstract Full Text PDF PubMed Scopus (94) Google Scholar, 3Lanes R Recker B Fort P Lifshitz F. Low-dose oral clonidine.Arch Pediatr Adolesc Med. 1985; 139: 87-88Crossref Google Scholar, 5Slover RH Klingensmith G Gotlin RW Radcliffe J. A comparison of clonidine and standard provocative agents of growth hormone.Arch Pediatr Adolesc Med. 1984; 138: 314-317Crossref Scopus (27) Google Scholar A significant decrease in cortisol and adrenocorticotropic (ACTH) hormone levels after a single oral dose of clonidine was also noted in a population of healthy adults6Lanes R Herrera A Palacios A Moncada G. Decreased secretion of cortisol and ACTH after oral clonidine administration in normal adults.Metabolism. 1983; 6: 568-570Abstract Full Text PDF Scopus (55) Google Scholar; recent studies have suggested that the fall in ACTH and cortisol concentrations during early morning clonidine testing is probably secondary to diurnal variation and is not drug induced. The use of a lower dose of oral clonidine than the 150 μg/m2 administered by Huang et al,1Huang C Banerjee K Sochett E Perlman K Wherrett D Daneman D. Hypoglycemia associated with clonidine testing for growth hormone deficiency.J Pediatr. 2001; 139: 323-324Abstract Full Text Full Text PDF PubMed Scopus (20) Google Scholar may diminish side effects, particularly the degree of somnolence, while still inducing rapid and sustained GH release in most patients studied.3Lanes R Recker B Fort P Lifshitz F. Low-dose oral clonidine.Arch Pediatr Adolesc Med. 1985; 139: 87-88Crossref Google Scholar, 7Laron Z Gil-Ad I Topper E. Clonidine: An effective growth hormone-releasing agent.J Pediatr. 1983; 102: 457-484Google Scholar, 8Dammacco F Dammacco A Cavallo T. Low oral dose of clonidine: An effective test for growth hormone reserve.J Pediatr. 1983; 103: 501-502Abstract Full Text PDF PubMed Scopus (6) Google Scholar We now routinely use 100 μg/m2 of oral clonidine for our GH testing, whereas other centers use even smaller doses. Routine bedside blood glucose monitoring at 30-minute intervals during clonidine testing in prepubertal children of short stature, may not always be feasible unless capillary blood glucose measurements are obtained. We suggest using a smaller dose of clonidine for GH testing, keeping patients in a recumbent position during the test because mild somnolence may occur, and avoiding abrupt changes in position because orthostatic hypotension may ensue. As stated by Huang et al,1Huang C Banerjee K Sochett E Perlman K Wherrett D Daneman D. Hypoglycemia associated with clonidine testing for growth hormone deficiency.J Pediatr. 2001; 139: 323-324Abstract Full Text Full Text PDF PubMed Scopus (20) Google Scholar make sure patients are alert and are offered and ingest an age-appropriate amount of food before discharge from the testing facility." @default.
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