Endocrine Abstracts

GH therapy has been reported to increase insulin resistance, but overt diabetes is rare. We present a young girl who developed symptoms of diabetes whilst on GH therapy with resolution of symptoms and normalisation of blood glucose profile on reducing the dose of GH.

Case report: A 14-year-old girl with background of prematurity, learning difficulty, cerebral palsy, scoliosis, and pan hypopituitarism presented with chest infection, high blood glucose levels (32 mmol/l) and polyuria. She was on hormone replacement therapy with GH, thyroxine, and hydrocortisone. She was commenced on basal bolus insulin regimen but insulin doses needed to be increased rapidly to around 2 units/kg per day, due to persistently elevated blood glucose readings.

Her HbA1c was 75 mmol/mol, but islet cell and glutamic acid decarboxylase antibodies were later found to be negative. Looking back at her auxology data, it was noted that there had been difficulty in getting an accurate height measurements in clinics due to scoliosis. She had been on GH treatment dose at 32 μg/kg per day for past 2 years. Her latest IGF1 levels were markedly elevated at 1363 μg/l (RR 230–950 for her age). In view of her diagnosis of diabetes, the dose of GH was reduced to adult replacement dose. Within 6 weeks her bolus insulin was stopped due to recurrent severe hypoglycaemia. 12 months later her long acting insulin analogue could be stopped. Her blood glucose profile remained stable in near normal range with latest HbA1c of 37 mmol/mol.

Conclusion: GH treatment has potential to cause insulin resistance. For children with disability assessing height velocity can be a challenge and clinicians should be vigilant about reducing the dose of GH to adult replacement dose in a timely manner.