Education Resource from the Society for Endocrinology
P Musson
Paediatric Endocrine Nurse, Southampton
Endocrine Nurses Training Course 10-12
September 2003
St Aidan's College, University of Durham, Windmill Hill, Durham DH1 3LJ
The Pituitary Gland lies at the base of the brain. It makes several hormones (chemical messengers) which act on other parts of the body. One of these hormones is called Growth Hormone, which as the name suggests is needed for normal growth during childhood.
In children and adults, Growth Hormone levels vary a lot throughout the day and night, during exercise, stress, sleep and other hormonal changes. Most of the time during the day, levels of Growth Hormone in the blood are very low and are difficult to measure. This means it is necessary to stimulate the release of Growth Hormone, to accurately assess how much your child is able to produce.
Your child will be given a small dose of Glucagon which by altering blood sugar stimulates their body to release Growth Hormone. Your child should have nothing to eat or drink after midnight on the night before their test, and will not be able to eat during the test (approximately 3-4 hours). Your child can drink water if thirsty. They will be able to eat and drink again normally as soon as the test is finished.
Soon after admission the nurse or doctor will insert a very small plastic tube (called a cannula) into your child’s arm or the back of their hand. This cannula will be used to take small blood samples throughout the test.
While it is in place the cannula doesn’t hurt but your child will have a splint and bandage put on their arm to keep it straight and some find this a little uncomfortable. To help stop the cannula blocking an infusion of salt water is started (a ‘drip’).
Soon after this the Glucagon is given by injection into the muscle in their thigh or bottom. We will take blood samples from the cannula every 30 minutes for the next 2-3 hours. The cannula is removed shortly before your child is ready to go home.
Glucagon affects the blood sugar levels; the levels rise during the first hour and then fall. The most common effects of a low blood sugar are drowsiness, hunger, feeling sick and sweatiness. Your child may look pale and be grumpy or confused. Some children may be sick. Giving a sweet drink such as Lucozade quickly reverses these effects.
Very rarely, a child can experience unconsciousness and fits. If needed we will give Dextrose (sugar solution) through the cannula. Your child will be closely monitored throughout the test, and we very much value your opinion about how your child seems compared to normal.
We will continue to observe your child closely, they should be encouraged to sit up and then have something fairly substantial to eat and drink. We can order something from the kitchen; you can bring in a packed lunch or buy your child something from the shop/café. We would strongly advise that you do not offer food from the Burger King, as this will almost certainly make your child sick.
When your child has eaten their meal they will be assessed by a senior nurse and the ‘drip’ removed. Most children have recovered within 2 hours of the test finishing. Occasionally this takes longer and rarely a child may need to stay in hospital overnight.
There should not be any long lasting effects from the test; your child should be encouraged to eat well at teatime to prevent their blood sugar becoming too low. By the following day they should be back to normal.
Are usually available in 2 weeks and you can telephone the Endocrine Nurses for them. You can then discuss any further tests or treatment recommended with the team at your next clinic appointment.
Pauline Musson / Rachel McWilliam. Paediatric Endocrine Nurses. 01.03.02.
The opinions expressed in this paper are those of the speaker and do not necessarily reflect the views of the Society