title: Nocturnal hypoglycemia identified by a continuous glucose monitoring system in patients with primary adrenal insufficiency (Addison's Disease).
abstract: BACKGROUND
  Hypoglycemia can be a symptom in patients with Addison's disease. The common regimen of replacement therapy with oral glucocorticoids results in unphysiological low cortisol levels in the early morning, the time of highest insulin sensitivity. Therefore patients with Addison's disease are at risk for unrecognized and potentially severe nocturnal hypoglycemia also because of a disturbed counterregulatory function. Use of a continuous glucose monitoring system (CGMS) could help to adjust hydrocortisone treatment and to avoid nocturnal hypoglycemia in these patients.
  
  
  METHODS
  Thirteen patients with Addison's disease were screened for hypoglycemia wearing a CGMS for 3-5 days.
  
  
  RESULTS
  In one patient we identified a hypoglycemic episode at 3:45 a.m. with a blood glucose level of 46 mg/dL, clearly beneath the 95% tolerance interval of minimal glucose levels between 2 and 4 a.m. (53.84 mg/dL). After the hydrocortisone replacement scheme was changed, the minimum blood glucose level between 2 and 4 a.m. normalized to 87 mg/dL.
  
  
  CONCLUSIONS
  Continuous glucose monitoring can detect nocturnal hypoglycemia in patients with primary adrenal insufficiency and hence prevent in these patients an impaired quality of life and even serious adverse effects.
authors.affiliation: Department of Endocrinology and Diabetes, University Hospital, Frankfurt, Germany. gesine.meyer@kgu.de
authors.forename: Gesine
authors.initials: G
authors.lastname: Meyer
authors.forename: Annika
authors.initials: A
authors.lastname: Hackemann
authors.forename: Juergen
authors.initials: J
authors.lastname: Reusch
authors.forename: Klaus
authors.initials: K
authors.lastname: Badenhoop
mesh_terms: D000224:Addison Disease / Q000097:blood / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy; D000328:Adult; D000368:Aged; D001786:Blood Glucose / Q000378:metabolism*; D015190:Blood Glucose Self-Monitoring / Q000379:methods*; D002940:Circadian Rhythm; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000008:administration & dosage*; D007003:Hypoglycemia / Q000097:blood / Q000175:diagnosis* / Q000209:etiology / Q000517:prevention & control; D008297:Male; D008875:Middle Aged; D018670:Monitoring, Ambulatory; D008991:Monitoring, Physiologic / Q000379:methods; D010349:Patient Compliance; D010353:Patient Education as Topic; D012189:Retrospective Studies; D055815:Young Adult
chemical_list: D001786:Blood Glucose; D006854:Hydrocortisone