ESPE Abstracts

A 15 year old girl presented with severe symptomatic hypoglycaemia. Diagnostic work up revealed only a diminished GH secretion at and during severe hypoglycaemia and after arginine stimulation. Injection of GH twice daily abolished the hypoglycaemia for several days. For practicability a treatment with long acting GH (Ngenla) 46 mg/week was started. Symptoms were not entirely abolished, so that the dose was increased to 54 mg /week which was successful. However 2 weeks after the increase of the dose, body weight augmented up to 10 kg and the patient developed rapidly growing oedema in extremities over a few days. IGF 1 was increased (823 µg/l) as well as tubular reabsorption of sodium (99.51 %) with normal serum electrolytes and good renal function. We stopped the long acting GH-therapy and started furosemide treatment over 6 days which abolished the fluid retention. Due to reoccurrence of hypoglycaemia we switched back to GH twice a day which reduced the oedema. Glucose levels remained stable and the patient without symptoms. IGF levels (616 µg/l) and tubular reabsorption of sodium (98,6%) decreased, while serum electrolytes remained unchanged. The observation demonstrates that during the treatment with long acting GH a significant fluid retention, probably based on increased sodium retention, may occur. Thus, signs of fluid retention should be closely monitored during the treatment. Since serum sodium levels do not reflect the phenomenon, body weight, tubular reabsorption of sodium and body composition should considered as parameters.