Cortisol responses to the insulin hypoglycaemia test in children

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P M Crofton1, A C Don-Wauchope, L E Bath

  • 1Department of Paediatric Biochemistry, Royal Hospital for Sick Children, Edinburgh, UK. patricia.crofton@luht.scot.nhs.uk

Hormone Research
|December 3, 2003
PubMed

Insights

The peak cortisol response in children during the insulin hypoglycemia (IH) test occurs by 90 minutes. This response is age-dependent, with younger children showing higher peak cortisol levels.

Area of Science:

  • Pediatric Endocrinology
  • Endocrine Testing
  • Hormone Physiology

Background:

  • The insulin hypoglycemia (IH) test is a standard method for assessing the hypothalamic-pituitary-adrenal (HPA) axis in children.
  • Establishing precise reference data for cortisol response timing is crucial for accurate pediatric endocrine diagnostics.

Purpose of the Study:

  • To determine the peak cortisol response timing during the IH test in pediatric patients.
  • To establish normative pediatric reference data for cortisol levels following IH testing.
  • To investigate the relationship between age and peak cortisol response in children.

Main Methods:

  • Retrospective review of IH tests in children under 16 years at a tertiary pediatric endocrine center.
  • Inclusion criteria: adequate hypoglycemia (glucose ≤ 2.0 mmol/l), exclusion of patients with HPA axis impairment or on glucocorticoids.
  • Blood samples analyzed for glucose, cortisol, and growth hormone at multiple time points post-insulin injection.

Main Results:

  • Peak cortisol and growth hormone (GH) responses were observed within 90 minutes in all subjects.
  • A significant inverse correlation was found between peak cortisol and age (rs -0.65, p<0.0001).
  • Median peak cortisol was higher in children younger than 10 years (689 nmol/l) compared to older children (555 nmol/l).

Conclusions:

  • The IH test sampling protocol in children can be shortened, with peak cortisol response identified by 90 minutes.
  • Peak cortisol response to IH testing is significantly influenced by age in pediatric populations.
  • These findings provide valuable reference data for pediatric endocrine assessment.
Abstract

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