0021-972X/90/7104-0952$02.00/0 Journal of Clinical Endocrinology and Metabolism Copyright © 1990 by The Endocrine Society

Vol. 71, No. 4 Printed in U.S.A.

Hypocortisolemia in Children Undergoing Evaluation for Growth Hormone Deficiency* STUART A. CHALEW, ZVI ZADIK, ROBERT McCARTER, AND A. AVINOAM KOWARSKI Department of Pediatrics, University of Maryland School of Medicine (S.A.C., A.A.K.), Baltimore, Maryland 21201; and the Department of Pediatrics, Kaplan Hospital (Z.Z.), Rehouot, Israel

was associated with a blunted peak cortisol response to insulininduced hypoglycemia (367 ± 160 nmol/L compared to 464 ± 155 nmol/L in the other patients; (P < 0.05). None of the patients had obvious clinical symptoms of hypocortisolemia at the time of testing. In general, IC-F levels were not correlated with IC-GH. However, 10 patients who had subnormal IC-F values also had laboratory evidence of GH secretory defects; 7 had subnormal IC-GH levels but normal stimulated GH responses, and 3 had both subnormal responses to stimulation as well as subnormal IC-GH. The long term prognosis and management implications of hypocortisolemia diagnosed in this patient group require further evaluation. (J Clin Endocrinol Metab 7 1 : 952-957, 1990)

ABSTRACT. The group of children who have clinical manifestations of GH deficiency may potentially contain a large number of patients with secretory defects of cortisol. We assessed physiological cortisol secretion by measuring the 24-h integrated concentration of cortisol (IC-F) in a series of 105 patients, aged 7-19 yr, undergoing endocrinological evaluation for growth impairment possibly due to GH deficiency. The reference value for IC-F, established from 30 normal stature, normal weight children (controls), aged 7-18 yr, was 157 ± 41 nmol/L (mean ± 1 SD). There was no effect of age, gender, or pubertal status on IC-F in controls. The IC-F ©I patients was 150 ± 72 nmol/L. Twelve patients (11%) had IC-F values more than 2 SD below the mean (i.e.

Hypocortisolemia in children undergoing evaluation for growth hormone deficiency.

The group of children who have clinical manifestations of GH deficiency may potentially contain a large number of patients with secretory defects of c...
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