Neonatal hypoglycemia in a growth hormone registry: incidence and pathogenesis.
OBJECTIVE
To examine the characteristics of infants with neonatal hypoglycemia treated with growth hormone (GH) in order to gain insights into factors aiding in the identification of and timely treatment of hypopituitary neonates.


METHODS
The National Cooperative Growth Study (NCGS) database was examined to identify infants with neonatal hypoglycemia started on GH by 6 months of age. 169 infants (100 males, 69 females) were found and their data analyzed for physical characteristics, the presence of other hormone deficits, and the diagnostic methods used.


RESULTS
Mean +/- SD baseline length standard deviation score (SDS) was -1.5 +/- 1.8. 148/169 infants had hypopituitarism. Twelve had isolated GH deficiency (GHD). Nine had hypoglycemia without hypothalamic or pituitary pathology. Structural central nervous system (CNS) lesions and/or midline facial defects were present in 66/169. 55/100 males had micropenis. Although 158 infants had GHD, only 90 infants had it documented by stimulation testing (80) or a critical sample when hypoglycemic (10). Multiple hormone replacement therapy was necessary in 89% of the hypoglycemic infants.


CONCLUSIONS
The great majority of these hypoglycemic infants had GHD, usually secondary to hypopituitarism. Over 1/3 had structural lesions of the hypothalamic-pituitary area or midline facial defects. Although lengths may be normal in these infants, physical features such as micropenis or cleft lip and/or palate should suggest pituitary dysfunction as the etiology of their hypoglycemia. A critical blood sample for GH taken during hypoglycemia is a quick and definitive diagnostic tool.
Bell
Jennifer J
JJ
Department of Pediatrics, Columbia University College of Physicians & Surgeons, Columbia Presbyterian Medical Center, New York, NY 10032, USA. jjb4@columbia.edu
August
Gilbert P
GP
Blethen
Sandra L
SL
Baptista
Joyce
J
D002493:Central Nervous System Diseases / Q000150:complications; D005145:Face / Q000002:abnormalities; D005260:Female; D013006:Growth Hormone / Q000627:therapeutic use*; D019382:Human Growth Hormone / Q000172:deficiency; D006801:Humans; D007003:Hypoglycemia / Q000150:complications / Q000188:drug therapy* / Q000453:epidemiology* / Q000209:etiology; D007018:Hypopituitarism / Q000150:complications; D015994:Incidence; D007223:Infant; D008297:Male; D010413:Penis / Q000002:abnormalities; D012042:Registries; D043202:Steroid Metabolism, Inborn Errors / Q000150:complications / Q000209:etiology; D014481:United States / Q000453:epidemiology
D019382:Human Growth Hormone; D013006:Growth Hormone