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. 2004 May;89(5):472–478. doi: 10.1136/adc.2003.033431

Cortisol and growth hormone responses to spontaneous hypoglycaemia in infants and children

P Crofton 1, P Midgley 1
PMCID: PMC1719908  PMID: 15102645

Abstract

Aims: To evaluate responses of cortisol and growth hormone (GH) to spontaneous hypoglycaemia in infants and children.

Methods: Retrospective review of laboratory and clinical data in paediatric patients investigated for suspected hypoglycaemia over a five year period. Thirty patients (16 aged <3 months) had hypoglycaemia confirmed by laboratory analysis (glucose <2.5 mmol/l) and were compared with 26 patients (11 aged <3 months) with glucose ⩾2.5 mmol/l.

Results: The commonest causes of hypoglycaemia were transient hyperinsulinism in infants <3 months and intercurrent infection in those >6 months of age. In both hypo- and non-hypoglycaemic patients, cortisol was positively (rs +0.66 and +0.68) and GH inversely (rs –0.65 and –0.75) correlated with age. Hypo- and non-hypoglycaemic infants <3 months had median cortisol concentrations of 205 and 116 nmol/l respectively compared with 1370 and 736 nmol/l in hypo- and non-hypoglycaemic children >6 months. Conversely, median GH was 46.5 and 51.2 mU/l in hypo- and non-hypoglycaemic infants compared with 14.3 and 12.1 mU/l in older hypo- and non-hypoglycaemic patients. Older non-hypoglycaemic patients with glucose levels below the glycaemic thresholds established for cortisol and GH secretion in adults had higher cortisol and GH concentrations than patients whose glucose levels exceeded these thresholds.

Conclusions: Cortisol and GH responses to spontaneous hypoglycaemia in children are highly age dependent. Young infants mount a poor cortisol response compared with older infants and children. Children older than 6 months may have glycaemic thresholds for cortisol and GH similar to those established for adults.

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Figure 1 .

Figure 1

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Relation of cortisol and GH to age in 63 samples collected from 56 paediatric subjects investigated for suspected hypoglycaemia. (A) Cortisol in hypoglycaemic subjects (glucose <2.5 mmol/l). The three samples with cortisol <500 nmol/l in infants aged 8–10 months were from patients with persistent hyperinsulinism or reactive hypoglycaemia respectively (see text). (B) GH in hypoglycaemic subjects. The two samples with GH <10 mU/l in infants aged 8–10 months were from patients with persistent hyperinsulinism or reactive hypoglycaemia respectively (see text). (C) Cortisol in non-hypoglycaemic subjects (glucose ⩾2.5 mmol/l). (D) GH in non-hypoglycaemic subjects.

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Amiel S. A., Sherwin R. S., Simonson D. C., Tamborlane W. V. Effect of intensive insulin therapy on glycemic thresholds for counterregulatory hormone release. Diabetes. 1988 Jul;37(7):901–907. doi: 10.2337/diab.37.7.901. [DOI] [PubMed] [Google Scholar]
  2. Anand K. J., Hansen D. D., Hickey P. R. Hormonal-metabolic stress responses in neonates undergoing cardiac surgery. Anesthesiology. 1990 Oct;73(4):661–670. doi: 10.1097/00000542-199010000-00012. [DOI] [PubMed] [Google Scholar]
  3. Anand K. J., Sippell W. G., Schofield N. M., Aynsley-Green A. Does halothane anaesthesia decrease the metabolic and endocrine stress responses of newborn infants undergoing operation? Br Med J (Clin Res Ed) 1988 Mar 5;296(6623):668–672. doi: 10.1136/bmj.296.6623.668. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. Artavia-Loria E., Chaussain J. L., Bougnères P. F., Job J. C. Frequency of hypoglycemia in children with adrenal insufficiency. Acta Endocrinol Suppl (Copenh) 1986;279:275–278. doi: 10.1530/acta.0.112s275. [DOI] [PubMed] [Google Scholar]
  5. Collins J. E., Leonard J. V., Teale D., Marks V., Williams D. M., Kennedy C. R., Hall M. A. Hyperinsulinaemic hypoglycaemia in small for dates babies. Arch Dis Child. 1990 Oct;65(10):1118–1120. doi: 10.1136/adc.65.10.1118. [DOI] [PMC free article] [PubMed] [Google Scholar]
  6. Crofton P. M., Don-Wauchope A. C., Bath L. E., Kelnar C. J. H. Cortisol responses to the insulin hypoglycaemia test in children. Horm Res. 2003 Dec 1;61(2):92–97. doi: 10.1159/000075339. [DOI] [PubMed] [Google Scholar]
  7. Growth Hormone Research Society Consensus guidelines for the diagnosis and treatment of growth hormone (GH) deficiency in childhood and adolescence: summary statement of the GH Research Society. GH Research Society. J Clin Endocrinol Metab. 2000 Nov;85(11):3990–3993. doi: 10.1210/jcem.85.11.6984. [DOI] [PubMed] [Google Scholar]
  8. Hanna C. E., Keith L. D., Colasurdo M. A., Buffkin D. C., Laird M. R., Mandel S. H., Cook D. M., LaFranchi S. H., Reynolds J. W. Hypothalamic pituitary adrenal function in the extremely low birth weight infant. J Clin Endocrinol Metab. 1993 Feb;76(2):384–387. doi: 10.1210/jcem.76.2.8381799. [DOI] [PubMed] [Google Scholar]
  9. Hawdon J. M., Weddell A., Aynsley-Green A., Ward Platt M. P. Hormonal and metabolic response to hypoglycaemia in small for gestational age infants. Arch Dis Child. 1993 Mar;68(3 Spec No):269–273. doi: 10.1136/adc.68.3_spec_no.269. [DOI] [PMC free article] [PubMed] [Google Scholar]
  10. Hindmarsh P. C., Swift P. G. An assessment of growth hormone provocation tests. Arch Dis Child. 1995 Apr;72(4):362–368. doi: 10.1136/adc.72.4.362. [DOI] [PMC free article] [PubMed] [Google Scholar]
  11. Hughes D., Murphy J. F., Dyas J., Robinson J. A., Riad-Fahmy D., Hughes I. A. Blood spot glucocorticoid concentrations in ill preterm infants. Arch Dis Child. 1987 Oct;62(10):1014–1018. doi: 10.1136/adc.62.10.1014. [DOI] [PMC free article] [PubMed] [Google Scholar]
  12. Hume R., McGeechan A., Burchell A. Failure to detect preterm infants at risk of hypoglycemia before discharge. J Pediatr. 1999 Apr;134(4):499–502. doi: 10.1016/s0022-3476(99)70210-6. [DOI] [PubMed] [Google Scholar]
  13. LaFranchi S. Hypoglycemia of infancy and childhood. Pediatr Clin North Am. 1987 Aug;34(4):961–982. doi: 10.1016/s0031-3955(16)36297-6. [DOI] [PubMed] [Google Scholar]
  14. Miller J. D., Esparza A., Wright N. M., Garimella V., Lai J., Lester S. E., Mosier H. D., Jr Spontaneous growth hormone release in term infants: changes during the first four days of life. J Clin Endocrinol Metab. 1993 Apr;76(4):1058–1062. doi: 10.1210/jcem.76.4.8473381. [DOI] [PubMed] [Google Scholar]
  15. Morris A. A., Thekekara A., Wilks Z., Clayton P. T., Leonard J. V., Aynsley-Green A. Evaluation of fasts for investigating hypoglycaemia or suspected metabolic disease. Arch Dis Child. 1996 Aug;75(2):115–119. doi: 10.1136/adc.75.2.115. [DOI] [PMC free article] [PubMed] [Google Scholar]
  16. Petersen K. E. ACTH in normal children and children with pituitary and adrenal diseases. II. Plasma ACTH (cortisol and growth hormone) values during insulin hypoglycaemia--patients with idiopathic hypopituitarism and intracranial tumour. Acta Paediatr Scand. 1984 May;73(3):372–378. doi: 10.1111/j.1651-2227.1994.tb17750.x. [DOI] [PubMed] [Google Scholar]
  17. Schwartz N. S., Clutter W. E., Shah S. D., Cryer P. E. Glycemic thresholds for activation of glucose counterregulatory systems are higher than the threshold for symptoms. J Clin Invest. 1987 Mar;79(3):777–781. doi: 10.1172/JCI112884. [DOI] [PMC free article] [PubMed] [Google Scholar]
  18. Scott S. M., Watterberg K. L. Effect of gestational age, postnatal age, and illness on plasma cortisol concentrations in premature infants. Pediatr Res. 1995 Jan;37(1):112–116. doi: 10.1203/00006450-199501000-00021. [DOI] [PubMed] [Google Scholar]
  19. Stanley C. A., Baker L. The causes of neonatal hypoglycemia. N Engl J Med. 1999 Apr 15;340(15):1200–1201. doi: 10.1056/NEJM199904153401510. [DOI] [PubMed] [Google Scholar]
  20. Vigneri R., D'Agata R. Growth hormone release during the first year of life in relation to sleep-wake periods. J Clin Endocrinol Metab. 1971 Sep;33(3):561–563. doi: 10.1210/jcem-33-3-561. [DOI] [PubMed] [Google Scholar]
  21. WILLIAMSON D. H., MELLANBY J., KREBS H. A. Enzymic determination of D(-)-beta-hydroxybutyric acid and acetoacetic acid in blood. Biochem J. 1962 Jan;82:90–96. doi: 10.1042/bj0820090. [DOI] [PMC free article] [PubMed] [Google Scholar]
  22. Wollmann H. A. Growth hormone and growth factors during perinatal life. Horm Res. 2000;53 (Suppl 1):50–54. doi: 10.1159/000053205. [DOI] [PubMed] [Google Scholar]

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