ESPE Abstracts

A 15y old girl presented with severe hypoglycaemic symptoms in combination with low blood glucose levels (<60 mg/dl). She had symptoms for over 1 year in combination with reduced activity, development of oligomenorrhoea after 2 years of normal cycles, increased fluid intake. Continuous sc. glucose measurement revealed constantly low or reduced glucose levels apart from a few increases after meals. Metabolic laboratory testing was normal apart from a single diminished GH level during hypoglycaemia. Insulin and C-peptide levels were appropriate to glucose levels with no sign of hyperinsulinism. MRI’s from brain and abdomen were normal. Oral glucose tolerance test showed normal increase of serum glucose, high normal insulin levels decreasing appropriately in relation to glucose levels. However, after 3 hours, serum glucose fell to 54 mg/dl. Laboratory investigations afterwards every 20 min up to 1 hour show a low GH levels (< 5ng/ml and a low but normal cortisol increase (>12 mg/dl) with normal values for all other parameters of glucose metabolism. Then, after an arginine infusion test, GH values were below 8 ng/ml so that an insufficient GH secretion was diagnosed. Treatment with GH was started. Since 2 injections of GH/d were necessary to prevent hypoglycaemia, we started with long acting GH (Ngenla) 46 mg/week. Subcutaneous glucose levels rose but still on 2 occasions hypoglycaemia occurred. Treatment was increased to 54 mg/week. Glucose levels still were in the lower normal range but no glucose levels below 70 mg/dl were encountered and the girl remained without hypoglycaemic symptoms together with an overall improvement of activity and wellbeing. The patient presents an unusual symptom of GH deficiency at this age. Continuous increase of GH levels with a long acting GH preparation abolished the symptoms.