Abstract
Insulin hypoglycemia (IH) is one of the most valuable procedures to test the pituitary ACTH reserve - especially as part of the combined test of hypothalamic-pituitary function. The ACTH response to IH is a steep increase from the time of maximal hypoglycemia (30 min. after insulin) to a peak value around 40 min. and lower values at 60 min. Reference values in 54 children studied for short stature and/or delayed puberty were 0 min: 11-82 pg/ml - 40 min: 50-300 pg/ml (very few in the "border line area" 50-70 pg/ml). Using these reference values and a peak plasma cortisol value of 400 nmol/1 normal response were found in 29 of 39 children with hypothalamic-pituitary dysfunction (10 with tumour) - 11 of which had "border line" response. In 10 children ACTH deficiency was demonstrated. From a clinical point of view 8 children (with low or border line response) were considered to have adrenocortical insufficiency and were treated with cortisone. In the individual patients the correlation between ACTH and cortisol response is good, R = 0.67 (p < 0.001).
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Petersen, K. Assessment of ACTH deficiency in children with hypothalamic-pituitary dysfunction. Pediatr Res 15, 1571 (1981). https://doi.org/10.1203/00006450-198112000-00217
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DOI: https://doi.org/10.1203/00006450-198112000-00217