34396
document
The impact of fasting and treatment omission on susceptibility to hypoglycaemia in children and adolescents with GH and cortisol insufficiency . OBJECTIVE Hypoglycaemia may be a frequent occurrence in young GH deficient patients and so we studied the response to fasting in children and adolescents with GH and/or cortisol deficiency . METHODS A total of 20 patients ( 2-18 years ) fasted for 14 h ( 22.00-12.00 h ) on two occasions as part of a randomized cross-over study . Fourteen had pituitary hormone deficiency ( PHD ) including GH deficiency ( GHD ) . Of the 14 patients , seven were ACTH sufficient ( PHDC+ ) and seven ACTH deficient ( PHDC- ) . Six had primary adrenal failure ( PAF ) . Subjects administered or omitted their normal dose of evening GH and/or morning hydrocortisone . Glucose , insulin , GH , cortisol , ketones and catecholamines were measured at 04.00 h and regularly from 07.00 to 12.00 h. Insulin sensitivity was assessed by HOMA and hypoglycaemia defined as a blood glucose ( BG ) < /= 3.3 mmol/l . RESULTS BG was related to age and body mass index on treatment but no subject became hypoglycaemic on or off therapy prior to 07.00 h. Five children ( aged 3 , 4 , 7 , 8 and 11 years ) were hypoglycaemic between 07.00 and 12.00 h off treatment . There was a positive relationship between GH AUC and minimum BG in patients with PHD on treatment ( r ( 2 ) = 0.45 , P = 0.012 ) with increased insulin sensitivity off treatment . Increased cortisol levels were seen in PHDC+ patients off GH ( P < 0.001 ) . A negative relationship was observed between minimum BG and adrenaline ( r ( 2 ) = 0.37 , P = 0.01 ) , ketone bodies ( r ( 2 ) = -0.20 , P = 0.05 ) and NEFA ( r ( 2 ) = -0.35 , P = 0.02 ) . Noradrenaline levels were reduced in patients with PHDC- . Low BMI ( on treatment ) and young age ( off treatment ) were determinants of low BG levels in a multiple regression model . CONCLUSIONS Unrecognized overnight hypoglycaemia in children and adolescents on pituitary hormone replacement is uncommon but BG levels quickly become abnormal when treatment and meals are omitted . The insulin antagonistic actions of GH are important in preventing hypoglycaemia . Patients with PHD have altered sympathetic nerve activity .
34397
Intervention_Physical
fasting
34398
Intervention_Pharmacological
treatment omission
34399
Intervention_Other
fasted
34400
Intervention_Pharmacological
evening GH
34401
Intervention_Pharmacological
morning hydrocortisone
34402
Outcome_Physical
susceptibility to hypoglycaemia
34403
Outcome_Physical
Glucose
34404
Outcome_Physical
insulin
34405
Outcome_Physical
GH
34406
Outcome_Physical
cortisol
34407
Outcome_Physical
ketones
34408
Outcome_Physical
catecholamines
34409
Outcome_Physical
Insulin sensitivity
34410
Outcome_Other
HOMA
34411
Outcome_Physical
hypoglycaemia
34412
Outcome_Physical
blood glucose
34413
Outcome_Physical
age and body mass index
34414
Outcome_Physical
hypoglycaemic
34415
Outcome_Physical
GH AUC
34416
Outcome_Physical
minimum BG
34417
Outcome_Physical
insulin sensitivity
34418
Outcome_Physical
Increased cortisol levels
34419
Outcome_Physical
BG
34420
Outcome_Physical
adrenaline
34421
Outcome_Physical
ketone bodies
34422
Outcome_Physical
Noradrenaline levels
34423
Outcome_Physical
BMI
34424
Outcome_Physical
low BG levels
34425
Outcome_Physical
BG levels
34426
Outcome_Physical
insulin antagonistic actions of GH
34427
Outcome_Physical
sympathetic nerve activity
34428
Participant_Age
children
34429
Participant_Age
adolescents
34430
Participant_Condition
GH and cortisol insufficiency
34431
Participant_Age
young
34432
Participant_Condition
GH deficient
34433
Participant_Age
children
34434
Participant_Age
adolescents
34435
Participant_Condition
GH and/or cortisol deficiency
34436
Participant_Sample-size
20 patients
34437
Participant_Age
( 2-18 years
34438
Participant_Age
Fourteen
34439
Participant_Condition
pituitary hormone deficiency ( PHD )
34440
Participant_Condition
GH deficiency ( GHD )
34441
Participant_Sample-size
14
34442
Participant_Sample-size
seven
34443
Participant_Sample-size
seven
34444
Participant_Condition
ACTH deficient ( PHDC- )
34445
Participant_Sample-size
Six
34446
Participant_Condition
primary adrenal failure ( PAF )
34447
Participant_Condition
PHDC-
34448
Participant_Age
children
34449
Participant_Age
adolescents
34450
Participant_Condition
PHD