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Context  dexamethasone has been demonstrated to elicit GH secretion in adults, but few data are available about its effectiveness as a provocative  stimulus  in the diagnostic work-up of GH deficiency (GHD) in childhood.    Objective  to assess the clinical value of dexamethasone stimulation test (DST) as a diagnostic tool for pediatric GHD.    Design and setting  retrospective single-center analysis. The study population included 166 patients with a pathological response to arginine stimulation test (AST, first-line test) and subsequently tested with either insulin tolerance test (ITT) or DST as a second-line investigation between 2008 and 2019.    Main outcome measures  comparison between GH peaks and secretory curves induced by ITT and DST; degree of agreement between DST and AST  versus  ITT and AST.    Results  the pathological response to AST (GH peak < 8 ng/mL) was confirmed by an ITT in 80.2% (89/111) of patients and by a DST in 76.4% (42/55), with no statistical difference between the two groups ( p  value 0.69). Mean GH peaks achieved after ITT and DST were entirely comparable (6.59 ± 3.59  versus  6.50 ± 4.09 ng/ml, respectively,  p  0.97) and statistically higher than those elicited by arginine ( p  < 0.01 for both), irrespectively of the average GH peaks recorded for each patient (Bland-Altman method). Dexamethasone elicited a longer lasting and later secretory response than AST and ITT. No side effects were recorded after DST.    Conclusions  DST and ITT confirmed GHD in a superimposable percentage of patients with a pathological first-line test. DST and ITT share a similar secretagogue potency, overall greater than AST.

frontiers in endocrinology

Dexamethasone Stimulation Test in the Diagnostic Work-Up of Growth Hormone Deficiency in Childhood: Clinical Value and Comparison With Insulin-Induced Hypoglycemia