BSPED2015 e-Posters Adrenal (12 abstracts)
Cortisol responses to the insulin tolerance test and glucagon stimulation tests in children with idiopathic short stature and idiopathic isolated growth hormone deficiency
Hussain Alsaffar , Iyad Ahmed , Pauline Blundell , Urmi Das , Poonam Dharmaraj , Mohammed Didi , Lynne Hatchard , Renuka Ramakrishnan , Senthil Senniappan , Kelly Stirrup , Zoe Yung & Joanne Blair
Alder Hey Children’s Hospital, Liverpool, UK.
Introduction: The insulin tolerance test (ITT) and glucagon stimulation test (GST) stimulate the release of both growth hormone (GH) and cortisol. A normal cortisol response is considered to be >500 nmo/l, however there are no robust normative paediatric data. Cortisol results may generate anxiety and further investigations in short children, tested for GH deficiency, with no clinical suggestion of cortisol deficiency.
Aim: To describe cortisol response in the ITT and GST in children with idiopathic short stature (ISS) and idiopathic isolated growth hormone deficiency (IIGHD).
Methods: Between January 2011 and December 2014, 502 children underwent ITT or GST for investigation of short stature. Data from children with ISS (birth weight SDS >−2, peak GH >6.1 μg/l, no evidence of chronic illness and no steroid therapies) and IIGHD (peak GH <6.1 μg/l) were included.
Results: Data from 118 (76 M) patients, age 12.9 yrs (1.7–20.7) were studied. Results are given in
| ISS | GST (n=43) | ITT (n=26) | |||
| Males (23) | Females (20) | Males (19) | Females (7) | ||
| Age (years) median, range | 8.59 (1.73–18.51) | 9.6 (2.11–16.16) | 16.68 (7.22–20.67) | 15.86 (11.69–17.81) | |
| Baseline cortisol (nmol/l) median, range | 232 (149-643) | 249.5 (131-419) | 279 (105–532) | 260 (152–657) | |
| Peak cortisol level (nmol/l) median, range | 450 (228–1082) | 608 (309–963) | 552(408–668) | 624(488–919) | |
| IIGHD | GST (n=19) | ITT (n=30) | |||
| Males (13) | Females (6) | Males (21) | Females (9) | ||
| Age (years) median, range | 8.17 (4.84–18.24) | 12.3 (4.02–16.88) | 14.8 (6.92–18.85) | 14.23 (10.34–17.55) | |
| Baseline cortisol (nmol/l) median, range | 264 (125–458) | 364 (252–604) | 287 (149–715) | 199 (114–632) | |
| Peak cortisol level (nmol/l) median, range | 585 (414–966) | 668 (417–717) | 555 (508–767) | 579 (497–734) | |
Conclusion: These data suggest that the current definition of a normal cortisol response to the ITT and GST should be re-examined. In a larger cohort, the effect of age and gender could be explored, to refine guidelines for the diagnosis of adrenal insufficiency in childhood and adolescence.
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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