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Cited by 22Adrenal Hormones and DisordersDiabetes Management and ResearchPituitary Gland Disorders and Treatments

Usage of continuous glucose monitoring (cgm) for detecting an unrecognized hypoglycemia and management of glucocorticoid replacement therapy in adult patients with central hypoadrenalism

Open access
Watanabe, Takuya, Ozawa, Atsushi, Ishii, Sumiyasu, Tomaru, Takuya, Shibusawa, Nobuyuki, Saito, Tsugumichi, Yamada, Eijiro, Horiguchi, Kazuhiko +9 more·2018·Endocrine Journal
DOI 10.1507/endocrj.ej16-0387
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Abstract

Patients with adrenal insufficiency require appropriate glucocorticoid replacement therapy; however, reliable biological parameters for optimizing glucocorticoid supplementation are limited. The physician has to rely primarily on clinical judgment, carefully taking into account signs and symptoms potentially suggestive of over- or under-replacement. We have found that some patients who are viewed as receiving sufficient doses of glucocorticoids occasionally exhibit morning headache or morning discomfort, which may be caused by unrecognized nocturnal hypoglycemia. Our aim in this study was to evaluate the usefulness of continuous glucose monitoring (CGM) for detecting unrecognized hypoglycemia and optimizing glucocorticoid replacement therapy in adult patients with central hypoadrenalism. Six patients with central hypoadrenalism of various etiologies were included in this study. All patients exhibited occasional morning headache or discomfort. We performed CGM to measure plasma glucose levels in all patients, and CGM identified unrecognized hypoglycemia episodes at midnight and early in the morning in five patients (83%). The CGM findings were used to fine-tune the dosing and regimens of glucocorticoid replacement and to re-evaluate glucose levels to avoid further unrecognized hypoglycemic events. This optimization of hydrocortisone supplementation prevented additional nocturnal hypoglycemia incidences in all cases. The addition of L-thyroxine with hydrocortisone continued to provide favorable glycemic control. Occasional symptoms also improved after maintenance in all patients. These findings demonstrated that CGM may represent a powerful tool for identifying unrecognized hypoglycemia and for optimizing supplementary hormones in patients with central hypoadrenalism, thereby improving their quality of life.

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  • In that study, full resolution of symptoms was achieved when the timings and dosages of the patients' hydrocortisone were altered based on the continuous glucose monitoring readings.

    “Full resolution of symptoms was achieved when the timings and dosages of the patients’ hydrocortisone were altered based on the CGM readings (37).”

    From Hypoglycaemia in adrenal insufficiency (2023) · cites this paper as [37]

    The Discussion (page unavailable) says CGM results were used to fine-tune glucocorticoid doses and regimens, and Table 3 reports no hypoglycemic episodes after modification. But the Discussion describes morning headache and discomfort as diminished, not fully resolved; the case descriptions likewise report improvement rather than complete symptom resolution. (LLM, conf=0.90)

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  • Several studies using continuous glucose monitoring in adults with adrenal insufficiency have shown benefits by providing useful information on blood sugar trends.

    “Several studies conducted using CGM in adults with AI have shown benefits as they provided useful information on blood sugar trends.”

    From Hypoglycaemia in adrenal insufficiency (2023) · cites this paper as [37]

    The Abstract reports that this study used CGM to detect previously unrecognized hypoglycemia in adults with central hypoadrenalism and used the glucose findings to adjust treatment. It also mentions one earlier CGM study in adults with Addison’s disease. These passages support the benefit of CGM for showing glucose patterns, but document only two adult adrenal-insufficiency studies, not “several.” (LLM, conf=0.82)

    Experimental — accuracy not yet measured

  • In one study, continuous glucose monitoring detected unrecognised nocturnal hypoglycaemia in 5 out of 6 adults with central hypoadrenalism causing early morning headaches.

    “One study detected unrecognised nocturnal hypoglycaemia in 5 out of 6 adults with central hypoadrenalism causing early morning headaches.”

    From Hypoglycaemia in adrenal insufficiency (2023) · cites this paper as [37]

    The Abstract reports that CGM detected unrecognized hypoglycemia around midnight or early morning in five of six adults with central hypoadrenalism. The Discussion says the patients had occasional morning headache and/or discomfort, but describes nocturnal hypoglycemia as a possible cause, not an established cause of headaches in all five. (LLM, conf=0.86)

    Experimental — accuracy not yet measured

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Authors
Watanabe, T., Ozawa, A., Ishii, S., Tomaru, T., Shibusawa, N., Saito, T., Yamada, E., Horiguchi, K., Nakajima, Y., Matsumoto, S., Yoshino, S., Katano-Toki, A., Hashimoto, K., Mori, M., Okada, S., Satoh, T., & Yamada, M.
Affiliations
Gunma University (JP)
ORCID
Venue
Endocrine Journal
Publisher
Japan Endocrine Society
Published
2018
Volume
65
Issue
5
Pages
547-556
ISSN
  • 0918-8959 (ISSN-L)
  • 1348-4540
DOI
10.1507/endocrj.ej16-0387
OpenAlex
W2795400855
Cited by
22
References
33
Citations by year
2026: 2 · 2025: 4 · 2024: 4 · 2023: 5 · 2022: 1 · 2021: 3 · 2020: 3
FWCI
1.19
Type
journal article
Language
en
Open access
Locations
  • Endocrine Journal (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Adrenal Hormones and Disorders
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Pituitary Gland Disorders and Treatments
Keywords
continuous glucose monitoring, nocturnal hypoglycemia, adrenal insufficiency, glucocorticoid replacement therapy, morning headache, levothyroxine, glycemic control
MeSH terms
Adolescent, Adrenal Insufficiency, Adult, Aged, Blood Glucose, Female, Glucocorticoids, Humans, Hydrocortisone, Hypoglycemia, Male, Middle Aged, Quality of Life, Blood Glucose Self-Monitoring, Hormone Replacement Therapy, Young Adult

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