Hypoglycaemia-insulin test: discordant growth hormone and cortisol response in paediatric patients regarding recovery from hypoglycaemia with or without oral glucose solution.
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.
Yeste
Diego
D
Paediatric Endocrinology, Children's Hospital Vall d'Hebron, Autonomous University of Barcelona, Barcelona, Spain. dyeste@vhebron.net
Tomasini
Rosangela
R
Dodino
Gabriela
G
Gussinyé
Miquel
M
Potau
Neus
N
Carrascosa
Antonio
A
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
D007328:Insulin; D019382:Human Growth Hormone; D005947:Glucose; D006854:Hydrocortisone