Nocturnal hypoglycaemia in ACTH and GH deficient children: role of continuous glucose monitoring
Open accessAbstract
Summary: Objectives: To evaluate the usefulness of continuous glucose monitoring (CGM) to identify nocturnal hypoglycaemia in children affected by combined ACTH and GH deficiency and to optimize the hydrocortisone replacement therapy in these patients. Study design: Eleven patients with ACTH and GH deficiency (five boys and six girls, age 1·6–16·8 years) underwent CGM for 36 h, including two nights. At least two consecutive glucose levels <2·78 m m were considered hypoglycaemic episodes. The differences in age and doses of hydrocortisone and recombinant human growth hormone (rh GH) between children with and without hypoglycaemia were analysed. The percentage of the glucose values <3·33 m m and the mean glucose levels were also evaluated. Results: Continuous glucose monitoring demonstrated nocturnal hypoglycaemia lasting from 30 to 155 min (1·5% of the total monitoring time) in three cases (27%). No statistically significant differences in age and rh GH dose were observed between children with or without hypoglycaemia. Conversely, the difference in the hydrocortisone doses between the patients with and without hypoglycaemia resulted statistically significant (5·9 vs 8·5 mg/m²/day; P = 0·04). Eight patients presented glucose values less than 3·33 m m during 5% of the total monitoring time. Hydrocortisone dose showed significant positive linear relation with mean glucose level (r = 0·79, P = 0·0035) and inverse relation with time lags of glucose levels under 3·33 m m (r = −0·65, P = 0·03). Conclusions: Our study shows that CGM may represent a valuable tool to detect nocturnal asymptomatic hypoglycaemic episodes and optimize the hydrocortisone therapeutic regimen in children with ACTH and GH deficiency.
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Due to gastric acids and hepatic first-pass effect, the recommended glucocorticoid treatment in children with primary adrenal insufficiency is slightly higher, ranging between 6-12mg/m2/day.
“Due to gastric acids and hepatic first-pass effect, the recommended glucocorticoid treatment in children with primary AI is slightly higher, ranging between 6-12mg/m2/day (1, 49).”
From Hypoglycaemia in adrenal insufficiency (2023) · cites this paper as [49]
The Introduction (page unavailable) recommends hydrocortisone replacement for children, but specifies 6–8 mg/m²/day for central adrenal insufficiency, not 6–12 mg/m²/day for primary adrenal insufficiency. The cited paper does not give gastric acids or hepatic first-pass metabolism as the reason for a higher dose. (LLM, conf=0.87)
Experimental — accuracy not yet measuredChildren with secondary adrenal insufficiency may require a lower daily replacement dose (6-8mg/m2/day).
“Children with secondary AI may require a lower daily replacement dose (6-8mg/m2/day) (49).”
From Hypoglycaemia in adrenal insufficiency (2023) · cites this paper as [49]
The Introduction states that 6–8 mg/m²/day of hydrocortisone is considered an optimal replacement regimen for children with central adrenal insufficiency. It does not establish that this dose is lower than a dose required by another group. The Discussion also notes hypoglycaemia near the lower end of the range and favors 8 mg/m²/day to reduce that risk. (LLM, conf=0.84)
Experimental — accuracy not yet measuredContinuous glucose monitoring in children with combined congenital central adrenal insufficiency and growth hormone deficiency identified severe asymptomatic nocturnal hypoglycaemia (< 2.7 mmol/L) in 3 out of 11 children, with the period of hypoglycaemia ranging from 30 to 150 minutes.
“CGM in children with combined congenital central adrenal insufficiency and growth hormone deficiency have identified severe asymptomatic nocturnal hypoglycaemia (< 2.7mmol/L) in 3 out of 11 children, with the period of hypoglycaemia ranging from 30 to 150 minutes.”
From Hypoglycaemia in adrenal insufficiency (2023) · cites this paper as [49]
The Results report CGM-detected hypoglycaemia in three of 11 children, predominantly in the early morning, and the Discussion describes it as asymptomatic. The cited paper defines the threshold as <2.78 mmol/L and gives a duration of 30–155 minutes, rather than <2.7 mmol/L and 30–150 minutes. (LLM, conf=0.90)
Experimental — accuracy not yet measuredIn those children, daily doses of hydrocortisone were significantly lower in the 3 children with hypoglycaemia.
“On further review, they found that the daily doses of hydrocortisone were significantly lower in the 3 children and resolution of hypoglycaemia was seen when the doses were increased (49).”
From Hypoglycaemia in adrenal insufficiency (2023) · cites this paper as [49]
Resolution of hypoglycaemia was seen when the hydrocortisone doses were increased in those children.
“On further review, they found that the daily doses of hydrocortisone were significantly lower in the 3 children and resolution of hypoglycaemia was seen when the doses were increased (49).”
From Hypoglycaemia in adrenal insufficiency (2023) · cites this paper as [49]
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Cites
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Hypoglycaemia in adrenal insufficiency
Lee, S. C., Baranowski, E. S., Sakremath, R., Saraff, V., & Mohamed, Z. (2023) · Frontiers in Endocrinology · doi:10.3389/fendo.2023.1198519 · Cited by 32 · see citing works
“Children with secondary AI may require a lower daily replacement dose (6-8mg/m2/day) (49).”
BackgroundInfluential
- Authors
- Cambiaso, P., Schiaffini, R., Pontrelli, G., Carducci, C., Ubertini, G., Crea, F., & Cappa, M.
- Affiliations
- Bambino Gesù Children's Hospital (IT)
- Corresponding author
- Cambiaso, Paola
- Venue
- Clinical Endocrinology
- Publisher
- Wiley
- Published
- 2013-05-06
- Volume
- 79
- Issue
- 2
- Pages
- 232-237
- ISSN
- 0300-0664 (ISSN-L)
- 1365-2265
- OpenAlex
- W2049826219
- Cited by
- 21
- References
- 4
- Citations by year
- 2026: 1 · 2025: 1 · 2023: 2 · 2022: 1 · 2021: 3 · 2020: 3 · 2019: 1 · 2018: 1 · 2017: 5 · 2016: 2 · 2015: 1
- FWCI
- 0.26
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Clinical Endocrinology (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Adrenal Hormones and Disorders
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Growth Hormone and Insulin-like Growth Factors
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
- Keywords
- nocturnal hypoglycemia, ACTH deficiency, growth hormone deficiency, combined pituitary hormone deficiency, continuous glucose monitoring, hydrocortisone replacement, recombinant human growth hormone, children
- MeSH terms
- Adolescent, Adrenal Insufficiency, Adrenocorticotropic Hormone, Blood Glucose, Child, Child, Preschool, Female, Humans, Hydrocortisone, Hypoglycemia, Infant, Male, Monitoring, Physiologic, Biosensing Techniques, Human Growth Hormone
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