title: [Paradoxal growth hormone and cortisol response to hypoglycemia caused by endogenous hyperinsulinemia: a case report].
abstract: Growth hormone (GH) together with cortisol are two important counter-regulatory hormones maintaining normal glycemia. Hyperinsulinemic hypoglycemia is a disorder of this counter-regulation described in neonates. We report here a rare case of reversible dissociated hypopituitarism secondary to an insulinoma in a 38-year-old man referred for investigation of hypoglycemic episodes. Hormonal investigations were in favour of dissociated anterior pituitary failure, with growth hormone and corticotroph deficiency. The hypothalamic-pituitary MRI was normal. The fasting test argued in favour of a hyperinsulinemic hypoglycemia. The abdominal scan and the endoscopic ultrasound showed a mass within the tail of the pancreas. Distal pancreatectomy was performed. Histology disclosed an insulinoma. On follow-up, no hypoglycemic episodes recurred and cortisol and GH response to induced hypoglycemia was normal. Our clinical case shows that hyperinsulinemia and hypoglycemia in patients with insulinoma can give rise to functional growth hormone and corticotrophin deficiency. The pathophysiological mechanism of this defective counter-regulation remains to be clarified; some studies suggest it could be related to hyperinsulinemia-induced decreased in CRF secretion and GHRH pulse.
authors.affiliation: Service d'endocrinolodgie, CHU Hédi-Chaker, route El-Ain, 3029 Sfax, Tunisie. nkaffel@yahoo.fr
authors.forename: N
authors.initials: N
authors.lastname: Kaffel
authors.forename: E
authors.initials: E
authors.lastname: Chakroun
authors.forename: M
authors.initials: M
authors.lastname: Dammak
authors.forename: M
authors.initials: M
authors.lastname: Mnif
authors.forename: M
authors.initials: M
authors.lastname: Smaoui
authors.forename: N
authors.initials: N
authors.lastname: Charfi
authors.forename: I
authors.initials: I
authors.lastname: Bayrouti
authors.forename: M
authors.initials: M
authors.lastname: Abid
mesh_terms: D000328:Adult; D001786:Blood Glucose / Q000378:metabolism; D006728:Hormones / Q000097:blood; D019382:Human Growth Hormone / Q000097:blood* / Q000172:deficiency; D006801:Humans; D006854:Hydrocortisone / Q000097:blood* / Q000172:deficiency; D006946:Hyperinsulinism / Q000097:blood* / Q000150:complications; D007003:Hypoglycemia / Q000097:blood* / Q000209:etiology; D007018:Hypopituitarism / Q000097:blood / Q000209:etiology; D007340:Insulinoma / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery; D008297:Male; D010180:Pancreatectomy; D010190:Pancreatic Neoplasms / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery; D014463:Ultrasonography
chemical_list: D001786:Blood Glucose; D006728:Hormones; D019382:Human Growth Hormone; D006854:Hydrocortisone