Endocrine Abstracts

Introduction: Research suggests long-term survivors of childhood cancer have an increased risk of manifesting the metabolic syndrome including insulin resistance (IR) despite many survivors of childhood malignancy if anything being underweight. It has been suggested growth hormone deficiency may be a factor in IR.

Case report: We present a 20-year-old boy with partial hypopituitarism following allogenic bone marrow transplant in 1993 for treatment of acute myeloid leukaemia. Growth hormone had been commenced at age 14 because of falling growth velocity. At the adult clinic in 2005 he was noted to be depressed. He had stopped medication of thyroxine 75 mcgs, growth hormone 0.2 mg and penicillin. He was persuaded to recommence thyroxine. BMI was 24.9. Whilst off growth hormone, opportunity was taken to reassess pituitary function, in line with NICE guidelines.

Insulin stress test performed in January 2006 using two doses of actrapid insulin 0.15 u/kg body weight only achieved a nadir glucose of 3.0 mmol/l. Baseline cortisol was 788 nmol/l.

During a further test in March 2006 two doses of insulin 0.2 u/kg were used with nadir glucose of 2.8 mmol/l.

A third insulin stress test in February 2007 using 0.3 u/kg obtained nadir glucose of only 3.3 mmol/l.

IR was suspected and a 75 g oral glucose tolerance test was performed. Results demonstrated: fasting glucose 4.5 mmol/l, 60 min glucose 11.6 mmol/l and 120 min glucose 7.6 mmol/l, with corresponding insulin levels of 203, 4880 and 4960 pmol/l confirming severe IR.

Recent attempt of a glucagon test failed due to deteriorating venous access.

Conclusion: We present an adult with partial hypopituitarism and severe insulin resistance following treatment of leukaemia. This has led to practical problems in assessing growth hormone status.