title: High risk of adrenal insufficiency in adults previously treated for idiopathic childhood onset growth hormone deficiency.
abstract: The aim was to reevaluate a group of adults treated for idiopathic childhood onset GH deficiency (GHD) after 18 yr without GH treatment. Twenty-six (11 females) patients participated. All but two had isolated GHD. Childhood diagnosis was established by insulin tolerance test (ITT). The patients were retested with an ITT to evaluate adult GH status. In five patients, an arginine and a synacthen test were performed instead of an ITT. Eleven of 25 patients had a subnormal cortisol response to ITT or synacthen. Ten patients had a GH peak less than 3.0 microg/liter (0.5. +/- 0.5 microg/liter), whereas 16 patients displayed a normal GH response (12.3 +/- 10.6 microg/liter) after ITT. IGF-I values were decreased in the patients with a pathological retest as well as in patients with a normal GH response compared with controls (P < 0.005). In 26 idiopathic childhood onset GHD patients, 44% of the patients had developed adrenal insufficiency; 38.5% had persistent GHD in adulthood, using the same test in both childhood and adulthood. Patients having a normal GH test had decreased IGF-I levels, compared with controls, indicating impaired function of a seemingly normal GH axis. It is imperative that pituitary axes other than the GH axis are tested at regular intervals, even in the absence of GHD in adulthood.
authors.affiliation: Department of Endocrinology, Rigshospitalet, DK-2100 Copenhagen, Denmark. mlange@rh.dk
authors.forename: Martin
authors.initials: M
authors.lastname: Lange
authors.forename: Ulla
authors.initials: U
authors.lastname: Feldt-Rasmussen
authors.forename: Ole Lander
authors.initials: OL
authors.lastname: Svendsen
authors.forename: Knud William
authors.initials: KW
authors.lastname: Kastrup
authors.forename: Anders
authors.initials: A
authors.lastname: Juul
authors.forename: Jørn
authors.initials: J
authors.lastname: Müller
mesh_terms: D000309:Adrenal Insufficiency / Q000175:diagnosis / Q000209:etiology*; D000328:Adult; D003366:Cosyntropin; D003430:Cross-Sectional Studies; D005260:Female; D019382:Human Growth Hormone / Q000097:blood / Q000172:deficiency*; D006801:Humans; D006854:Hydrocortisone / Q000097:blood; D007328:Insulin; D007334:Insulin-Like Growth Factor I / Q000378:metabolism; D008297:Male; D008661:Metabolism, Inborn Errors / Q000150:complications; D018570:Risk Assessment
chemical_list: D007328:Insulin; D019382:Human Growth Hormone; D003366:Cosyntropin; C006418:adrenocorticotropin zinc; D007334:Insulin-Like Growth Factor I; D006854:Hydrocortisone