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Requirement for age-specific peak cortisol responses to insulin-induced hypoglycaemia in children

Michael J O'Grady1, Conor Hensey, Miriam Fallon

  • 1Department of Paediatric Endocrinology and Diabetes, Our Lady's Children's Hospital, Dublin 12, Ireland. michaelogrady@physicians.ie

European Journal of Endocrinology
|May 16, 2013
PubMed

Insights

A single peak cortisol threshold for insulin tolerance tests is inappropriate for children. Younger children show higher cortisol responses, and using adult standards may lead to overdiagnosing adrenal insufficiency in adolescents.

Area of Science:

  • Pediatric Endocrinology
  • Hormone Testing
  • Adrenal Insufficiency Diagnosis

Background:

  • Current pediatric reference ranges for basal morning cortisol exist.
  • Peak cortisol responses to insulin tolerance tests lack age-specific ranges.
  • Adult data suggests a peak cortisol response ≥500 nmol/l is normal.

Purpose of the Study:

  • To assess factors influencing cortisol response to insulin tolerance tests in children.
  • To determine if peak cortisol response in children is age-dependent.

Main Methods:

  • Retrospective cohort study of children and adolescents ≤18 years.
  • Analysis of insulin tolerance tests with adequate hypoglycemia.
  • Exclusion of patients with hypopituitarism, severe adrenal axis impairment, or glucocorticoid use.

Main Results:

  • Age was negatively associated with peak cortisol response (r=-0.15, P=0.03).
  • Lower peak cortisol (<500 nmol/l) was less common in children <12 years (9% vs 25%).
  • Median peak cortisol was higher in children <12 years (610 nmol/l) compared to those ≥12 years (574 nmol/l).

Conclusions:

  • A single peak cortisol threshold is unsuitable for all pediatric age groups.
  • Current thresholds may lead to overdiagnosis of adrenal insufficiency in adolescents.
  • Age-specific reference ranges for peak cortisol response are needed.
Abstract

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