Hussain, Khalid; (2002) Endocrine and metabolic studies in children with hypoglycaemia. Doctoral thesis (M.D), UCL (University College London).

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Abstract

Hypoglycaemia is one of the most common clinical problems seen in paediatric practice. Normoglycaemia is maintained by the interaction of various hormones such as insulin, glucagon, adrenaline, growth hormone (GH) and cortisol. GH and cortisol play important roles in the counter-regulatory hormonal response to hypoglycaemia. Although the GH and cortisol responses to hypoglycaemia induced by an Insulin Tolerence Test (ITT) are well defined there is very little literature on the GH and cortisol responses to spontaneous hypoglycaemia in childhood. Children and neonates referred with hypoglycaemia underwent a diagnostic fast. Serum GH and cortisol were measured before hypoglycaemia, at the time of hypoglycaemia and at ten-minute intervals for fifty minutes after the hypoglycaemia was corrected. The neonatal group included only babies with Hyperinsulinism of Infancy (HI). The serum GH and cortisol responses generated to spontaneous hypoglycaemia were compared with those in sixteen children undergoing the ITT. The results of this study showed that children with spontaneous hypoglycaemia generate inappropriately low serum GH responses at the time of hypoglycaemia which persists for fifty-minutes after hypoglycaemia. Serum GH levels were not influenced by physiological changes in serum Non-Esterified-Fatty-Acid or serum Ketone body concentrations. In contrast all children in the ITT group had appropnate serum GH responses at the time of hypoglycaemia. Serum cortisol responses were appropriate in children with spontaneous and ITT induced hypoglycaemia. Neonates with HI generated inappropriately poor serum cortisol responses. This was related to low serum Adreno- Corticotrophic Hormone (ACTH) levels. These neonates mounted a vigorous serum cortisol response when administered ACTH at the time of hypoglycaemia.

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