Arginine stimulation test
SPEG (Scottish Paediatric Endocrine Group)
- Patient to have water only for 8 hours prior to the test.
- Arginine may cause nausea and some irritation at the infusion site. A cannula of at least 22g should be used.
- In children with suspected hypopituitarism prolonged fasting may induce hypoglycaemia. Blood glucose should be checked by ward meter with each sample in these patients whenever a sample is taken.
- This test can be combined with synacthen test to assess adrenal cortisol production (but not ACTH deficiency), in addition to growth hormone deficiency.
Drug(s) Given
Arginine monochloride 0.5g/kg
Up to a maximum of 30g.
How Given
Dilute Arginine in equal quantities of 0.9% saline and infuse over 30 minutes.
For example, dose 0.5gms per kilo
20kg child = 10gms of arginine= 20mls of arginine solution (5gms in 10mls).
Add 20mls of arginine solution to 20mls of 0.9% saline.
Timing of Administration
Give after the first basal blood sample has been taken and the Capillary Blood Glucose is known.
| Time (minutes) | Action |
| -30 | Insert a reliable cannula (at least 22g). Take venous blood sample. Measure capillary blood glucose (CBG) using ward meter. Start the arginine infusion and give over 30 minutes. |
| 0 | Take venous blood sample. Measure CBG |
| 15 | Take venous blood sample. Measure CBG |
| 30 | Take venous blood sample. Measure CBG |
| 60 | Take venous blood sample. Measure CBG |
| 90 | Take venous blood sample. Measure CBG |
| 120 | Take venous blood sample. Measure CBG |
| Time (minutes) | |||||||
| -30 | 0 | 15 | 30 | 60 | 95 | 120 | |
| Glucose |  |
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| Cortisol 1 | |
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| IGF1 | |
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| T4, TSH | |
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1 If synacthen test is performed at the same time.
If the plasma GH concentration reaches 6.7 micrograms/L or more, further investigations are not indicated.
If the response is below this level, then an insulin hypoglycaemia test may be necessary.