title: Hypoglycaemia-insulin test: discordant growth hormone and cortisol response in paediatric patients regarding recovery from hypoglycaemia with or without oral glucose solution.
abstract: BACKGROUND
  Hypoglycaemia-insulin test (HIT) is the 'gold standard' for the diagnosis of adrenal-pituitary-hypothalamic axis disorders. Controversy exists on the convenience of recovery from an insulin-induced hypoglycaemia since this test is not risk-free.
  
  
  OBJECTIVE
  To ascertain whether recovery from insulin-induced hypoglycaemia with an oral glucose solution produces a different response of growth hormone (GH) and cortisol at different times of the study compared with spontaneous recovery from hypoglycaemia.
  
  
  METHODS
  Prospective study of 100 children and adolescents with growth delay who underwent an HIT. Patients were consecutively assigned to two groups of 50. In one group recovery from hypoglycaemia occurred spontaneously and in the other recovery was achieved with an oral glucose solution (20 g of glucose) when glycaemia was under 30 mg/dl. The two groups did not differ in age, sex, pubertal status, weight, height and IGF-I levels.
  
  
  RESULTS
  The response of GH at 30, 60, 90 and 120 min and cortisol at 10, 60, 90 and 120 min was lower and statistically significant in patients with recovery from hypoglycaemia with oral glucose solution. GH deficiency was diagnosed more frequently in patients recovered with glucose solutions (94%) compared to those with spontaneous recovery (68%).
  
  
  CONCLUSIONS
  Oral glucose solution administration when glycaemia was under 30 mg/dl in HIT produced a lower GH and cortisol response to insulin stimulus and a greater frequency of GH deficit diagnosis.
authors.affiliation: Paediatric Endocrinology, Children's Hospital Vall d'Hebron, Autonomous University of Barcelona, Barcelona, Spain. dyeste@vhebron.net
authors.forename: Diego
authors.initials: D
authors.lastname: Yeste
authors.forename: Rosangela
authors.initials: R
authors.lastname: Tomasini
authors.forename: Gabriela
authors.initials: G
authors.lastname: Dodino
authors.forename: Miquel
authors.initials: M
authors.lastname: Gussinyé
authors.forename: Neus
authors.initials: N
authors.lastname: Potau
authors.forename: Antonio
authors.initials: A
authors.lastname: Carrascosa
mesh_terms: D000293:Adolescent; D000886:Anthropometry; D016022:Case-Control Studies; D002648:Child; D005260:Female; D005947:Glucose / Q000627:therapeutic use; D006130:Growth Disorders / Q000097:blood* / Q000175:diagnosis; D019382:Human Growth Hormone / Q000097:blood* / Q000172:deficiency; D006801:Humans; D006854:Hydrocortisone / Q000097:blood*; D007003:Hypoglycemia / Q000097:blood* / Q000139:chemically induced / Q000188:drug therapy; D007030:Hypothalamo-Hypophyseal System / Q000503:physiopathology; D007328:Insulin / Q000008:administration & dosage / Q000097:blood; D008297:Male; D010901:Pituitary Function Tests / Q000379:methods*; D011627:Puberty / Q000097:blood; D013268:Stimulation, Chemical
chemical_list: D007328:Insulin; D019382:Human Growth Hormone; D005947:Glucose; D006854:Hydrocortisone