Requirement for age-specific peak cortisol responses to insulin-induced hypoglycaemia in children

O’Grady, Michael J.; Hensey, Conor; Fallon, M.; Hoey, Hilary; Murphy, Nuala; Costigan, Colm

doi:10.1530/eje-13-0084

Cited by 11 publications

(7 citation statements)

References 31 publications

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“…Those performed have included diverse study populations, and different stimulation tests, and none studied the relations between peak cortisol and age separately for each gender. Peak cortisol levels have been shown to decrease with age and to vary by sex and pubertal status after high-dose ACTH stimulation test [25] and after ITT [15,26]. Mushtaq et al [27] reported an inverse correlation between cortisol response to the 1-μg ACTH test and age in children with short stature and normal GH levels.…”

Section: Discussionmentioning

confidence: 99%

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The Intramuscular Glucagon Stimulation Test Does Not Provide Good Discrimination between Normal and Inadequate ACTH Reserve When Used in the Investigation of Short Healthy Children

2014

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Background/Aims: Few studies have addressed the role of the glucagon stimulation test (GST) in evaluating the hypothalamic-pituitary-adrenal axis in children. We investigated the diagnostic value of the GST in evaluating the adrenocortical response in short healthy children. Methods: The GST was performed in 190 children investigated for short stature. A peak cortisol >500 nmol/l was considered a normal response. In the 45 (23.7%) with subnormal response, a 250-μg ACTH test was done. Results: The rate of subnormal adrenal response to GST was higher among boys (33.9 vs. 8.9%, p < 0.001) and among children ≥6 years than among younger children (32.7 vs. 18.4%, p < 0.02). Both mean basal and peak cortisol levels were higher in girls than in boys: 381 ± 165 vs. 319 ± 151 nmol/l (p = 0.003) and 741 ± 102 vs. 595 ± 208 nmol/l (p < 0.001), respectively. Peak cortisol on GST was associated with basal cortisol (r = 0.45, p < 0.001) but not with glucose nadir (r = -0.31, p = 0.67), peak GH (r = 0.069, p = 0.33) or BMI-SDS (r = -0.08, p = 0.28). Peak cortisol was >500 nmol/l in all the patients undergoing an ACTH stimulation test. Conclusions: Since adrenal response to GST is age- and gender-related and the false-positive rate is high, its routine performance in healthy children warrants reconsideration.

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Section: Discussionmentioning

confidence: 99%

“…The detection limit was 27 nmol/l for cortisol. A peak cortisol >500 nmol/l was considered a normal response [15,16,17]. …”

Section: Methodsmentioning

confidence: 99%

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The Intramuscular Glucagon Stimulation Test Does Not Provide Good Discrimination between Normal and Inadequate ACTH Reserve When Used in the Investigation of Short Healthy Children

2014

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“…Cortisol concentrations in the early morning correlate strongly with peak cortisol concentrations in dynamic tests of adrenal function5 9 10 and have been reported to be helpful screening tests in children and young people. The sensitivity and specificity of a cortisol concentration <108 nmol/L at 9:00 for the diagnosis of adrenal insufficiency are reported to be 83% and 99%, respectively, while adrenal insufficiency is unlikely when 9:00 cortisol is >381 nmol/L 11…”

Section: Diagnostic Tests Of Adrenal Functionmentioning

confidence: 99%

The diagnosis and treatment of adrenal insufficiency during childhood and adolescence

2016

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The diagnosis and treatment of adrenal insufficiency in childhood and adolescence poses a number of challenges. Clinical features of chronic adrenal insufficiency are vague and non-specific, and mimic many other causes of chronic ill health. A range of diagnostic tests are available for the assessment of adrenal function, all of which have advantages and disadvantages. Cortisol responses to these tests may vary with age and between genders. Knowledge of normal cortisol levels during health and ill health in childhood is also limited, and the cortisol replacement therapies available in clinical practice enable only crude mimicry of physiological patterns of cortisol secretion. An awareness of the limitations of diagnostic tests and treatments is important, and critical clinical assessment, integrating clinical and biochemical data, is essential for the diagnosis and treatment of children with suspected adrenal insufficiency. The aim of this review is to draw on data from clinical studies to inform a pragmatic approach to the child presenting with symptoms of chronic adrenal insufficiency. Clinical features of primary and secondary adrenal insufficiency, and syndromes associated with these diagnoses are described. Factors to consider when selecting a diagnostic test of adrenal function and interpretation of test results are considered. Finally, the limitations of cortisol replacement therapy are also discussed.

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“…The cortisol values' amplitude is apparently greater in the pediatric population, and this might require large-cohort studies to determine reliable cortisol reference limits and covariates in childhood [35] . For cortisol analysis, the reference intervals are often method-specific, so different degrees of interference might result in very different reference limits that are not interchangeable.…”

Section: Cortisol Reference Limitsmentioning

confidence: 99%

Morning Serum Basal Cortisol Levels Are Affected by Age and Pubertal Maturation in School-Aged Children and Adolescents

Barra¹,

Silva²,

Rodrigues³

et al. 2015

Horm Res Paediatr

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Background: The same reference values for cortisol have been used for adults and children, but laboratory results obtained from an adult population might not be suitable for pediatric patients. Aims: To determine morning serum basal cortisol levels in children and adolescents. Methods: The study was conducted on 120 suitable reference individuals, healthy Brazilian children and adolescents from both genders aged 4-19 years old. The method used for cortisol assessment was the chemiluminescent enzyme immunoassay (VITROS® 5600 MicroWell; Johnson & Johnson, High Wycombe, UK, 2009), and the kit reference interval was 4.46-22.7 μg/dl (122.7-626.2 nmol/l). The setting limits were calculated according to the Clinical Laboratory Standards Institute guidelines. Results: The morning serum basal cortisol levels increased with age and pubertal maturation, but there were no differences based on gender. The cortisol reference values were established based on the 2.5th and 97.5th percentiles as 2.97 μg/dl [81.9 nmol/l, 90% confidence interval (CI) 1.44-3.69 μg/dl] and 23.4 μg/dl (645.5 nmol/l; 90% CI 16.3-26.4 μg/dl), respectively. Conclusions: The assessment of the morning serum basal cortisol levels showed a unique pattern, with a different lower limit for the cohort compared to current values established for adult subjects.

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Requirement for age-specific peak cortisol responses to insulin-induced hypoglycaemia in children

Cited by 11 publications

References 31 publications

The Intramuscular Glucagon Stimulation Test Does Not Provide Good Discrimination between Normal and Inadequate ACTH Reserve When Used in the Investigation of Short Healthy Children

The Intramuscular Glucagon Stimulation Test Does Not Provide Good Discrimination between Normal and Inadequate ACTH Reserve When Used in the Investigation of Short Healthy Children

The diagnosis and treatment of adrenal insufficiency during childhood and adolescence

Morning Serum Basal Cortisol Levels Are Affected by Age and Pubertal Maturation in School-Aged Children and Adolescents

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