Isolated growth hormone deficiency presenting with recurrent hypoglycaemia in a toddler

Abstract

Hypoglycaemia in infants and children is caused by a number of endocrine and metabolic defects, some of which are unique to this age group. Growth hormone deficiency (GHD) has been rarely reported as a cause of recurrent fasting hypoglycaemia in children. An 18-month-old male child presented to us for evaluation of neuroglycopenic symptoms caused by recurrent episodes of fasting hypoglycaemia. Laboratory evaluation revealed ketotic hypoinsulinaemic hypoglycaemia. The child was diagnosed to have GHD on the basis of two failed stimulation tests. A detailed work-up for metabolic and other hormonal causes of hypoglycaemia was negative. We present the case for its rarity and to highlight the importance of a detailed metabolic and hormonal assessment in evaluation of childhood hypoglycaemia.

A phenotypic expansion of TRNT1 associated sideroblastic anemia with immunodeficiency, fevers, and developmental delay

“…One additional report also described a child with SIFD who had short stature and GH deficiency (Kumaki et al, 2019). GH deficiency is a rare but well described cause of hypoglycemia in infants (Boro et al, 2019). This was thought to be Note: Analyte abnormalities shared by both patients on plasma metabolomics with associated Z-scores.…”

“…One additional report also described a child with SIFD who had short stature and GH deficiency (Kumaki et al, 2019). GH deficiency is a rare but well described cause of hypoglycemia in infants (Boro et al, 2019). This was thought to be responsible for Patient 1's hypoglycemia based on the response to therapy and the lack of evidence for a concomitant defect on biochemical testing.…”

Growth hormone deficiency and hypoglycemia: a case report

“…Similar to our case, midline defects were absent and there was no significant contributory history, Whipple's triad for the confirmation of hypoglycemia was fulfilled-signs and symptoms consistent with hypoglycemia, low documented plasma glucose and reversal of signs and symptoms with normalization of plasma glucose value. 5 Hypoglycemic seizures due to reduced GH can be overcome with GH replacement and the short stature due to GH deficiency can be improved with early replacement therapy. 8 The stored glycogen reserve of the brain lasts only for a short duration of minutes after the plasma glucose levels drop, hence, prolonged severe hypoglycemia can cause permanent neurological injury.…”

“…3 The possible causes for recurrent childhood hypoglycemia include hyperinsulinism, ketotic hypoglycemia, glycogen storage disorders, disorders of gluconeogenesis, glucose transporter defects, endocrine etiology: panhypopituitarism, isolated Adreno-corticotropic Hormone deficiency or rarely Growth Hormone (GH) deficiency. [4][5][6] Quarter to half of the cases with recurrent symptomatic hypoglycemia in early infancy may have permanent sequelae. 1…”