Table 4: Practical considerations for the management of glycaemic parameters in pituitary hyposecretory states.

Hypoglycaemia can be a manifestation of panhypopituitarism; children with GH deficiency have fasting hypoglycaemia. Appropriate screening should be considered in relevant situations

Hypogonadotropic hypogonadism and adult GH deficiency are associated with insulin resistance. Screen for DM when appropriate

Glucocorticoid replacement therapy can induce hyperglycaemia, with the characteristic pattern of an afternoon or evening rise in plasma glucose. Consider short-acting insulin prior to lunch

Hypoglycaemia is a recognised adverse effect of mecasermin. Appropriate precautions are advocated, including administration with food

DM = diabetes mellitus; GH = growth hormone.