Objectives Provocative growth hormone (GH) tests are widely used for diagnosing pediatric GH deficiency (GHD). A thorough understanding of the evidence behind commonly used interpretations and the limitations of these tests is important for improving clinical practice. Content To place current practice into a historical context, the supporting evidence behind the use of provocative GH tests is presented. By reviewing GH measurement techniques and examining the early data supporting the most common tests and later studies that compared provocative agents to establish reference ranges, the low sensitivity and specificity of these tests become readily apparent. Studies that assess the effects of patient factors, such as obesity and sex steroids, on GH testing further bring the appropriateness of commonly used cutoffs for diagnosing GHD into question. Summary and Outlook Despite the widely recognized poor performance of provocative GH tests in distinguishing GH sufficiency from deficiency, limited progress has been made in improving them. New diagnostic modalities are needed, but until they become available, clinicians can improve the clinical application of provocative GH tests by taking into account the multiple factors that influence their results.

中文翻译：

---

儿童刺激性生长激素测试：我们是如何来到这里的，我们现在要去哪里？

目的 刺激性生长激素 (GH) 测试广泛用于诊断小儿生长激素缺乏症 (GHD)。彻底了解常用解释背后的证据和这些测试的局限性对于改进临床实践很重要。内容 为了将当前的实践置于历史背景中，提供了使用刺激性 GH 测试背后的支持证据。通过回顾 GH 测量技术并检查支持最常见测试的早期数据以及后来比较刺激剂以建立参考范围的研究，这些测试的低灵敏度和特异性变得显而易见。评估患者因素（如肥胖和性类固醇）对 GH 测试影响的研究进一步使诊断 GHD 的常用临界值的适当性受到质疑。总结和展望 尽管人们普遍认为刺激性 GH 测试在区分 GH 充足和缺乏方面表现不佳，但在改进它们方面取得的进展有限。需要新的诊断方式，但在它们可用之前，临床医生可以通过考虑影响其结果的多种因素来改进刺激性 GH 测试的临床应用。