The Catecholamine Response to Hypoglycemia in Children with Isolated Growth Hormone Deficiency Syndromes and Multiple Pituitary Hormone Defects

Abstract

ABSTRACT. We examined the catecholamine response to insulin-induced hypoglycemia in 46 short children evaluated for growth hormone (GH) deficiency by both pharmacologic stimulation and integrated concentration of GH. Twelve patients had quantitatively normal GH secretion by both pharmacologic stimulation and integrated concentration of GH (GHNORM). Twenty-two patients had normal GH to pharmacologic stimulation but subnormal integrated concentration of GH (GHND). Twelve patients had GH deficiency by both tests (GHD): six had isolated GH deficiency (GHD type 1) and six had multiple hormone deficiencies (GHD type 2). There was no significant difference between the peak epinephrine, norepinephrine, and cortisol responses of GH-NORM, GHND, and GHD type 1 patients. The mean peak epinephrine response of GHD type 2 patients was significantly lower (564 f 561 pg/ml, p < 0.03) compared to the other patient groups. There was no significant difference between the peak norepinephrine levels between GHD type 2 patients and the remaining groups. There was no correlation between decrease in blood glucose and either increase in growth hormone, catecholamine, or cortisol concentrations. There was a significant correlation between log peak epinephrine and peak cortisol response (r = 0.53, p < 0.0002) of the 46 subjects. Neither the basal nor stimulated catecholamine levels correlated with the integrated concentration of cortisol. We conclude that 1) isolated GH deficiency is not associated with impairment of the catecholamine response to hypoglycemia; 2) impairment of the epinephrine response to hypoglycemia is only associated with multiple pituitary hormone deficiencies; 3) in children, the degree of glucose lowering is not correlated with the magnitude of peak GH, catecholamine, or cortisol responses. (Pediatr Res 20: 1097-1101, 1986 Abbreviations GH-NORM, patients with normal quantitative growth hormone levels by stimulation and IC-GH

Growth Hormone Deficiency Is Not Associated with Impaired Vagal Cholinergic Nervous System Activity in Children

“…In contrast to these studies, Polinksy et al (25) failed to show similar correlation in 11 adult volunteers. We have previously reported that the E and NE responses to insulin-induced hypoglycemia in children with isolated GH deficiency were not significantly different than the response of GHsufficient children (26). The present study extends these obser-HANUKOGLU ET AL vations to the parasympathetic division of the autonomic nervous system which is not impaired in GH deficiency disorders.…”

The impact of fasting and treatment omission on susceptibility to hypoglycaemia in children and adolescents with GH and cortisol insufficiency

“…Voorhess et al 34 . found that children with GHD but ACTH sufficient had no increase in noradrenaline in response to insulin induced hypoglycaemia whereas short normal children had a twofold increase, although others have observed a normal response to hypoglycaemia in those with GHD 35 . These observations may reflect a developmental defect of the sympathetic chain as well as the hypothalamo–pituitary axis in some of these patients.…”

Reactivity to stress and psychological adjustment in adults with pituitary insufficiency

“…Children with MPHD exhibit impaired adrenaline responses to the stress of hypoglycaemia (Chalew & Kowarski, 1986), while short children with normal pituitary function or with isolated GH deficiency, have normal responses. Although we made no measurements, failure of our MPHD subjects to secrete adequate adrenaline in response to stress could be responsible for our findings.…”