Experience with insulin-induced hypoglycemia as a provocative test for growth hormone and cortisol secretion in children.

Insulin-induced hypoglycemia has been used in 109 children with a variety of disorders to assess the hypothalamo-pituitary adrenal axis.The patients were divided into 3 groups: (1) patients with growth retardation and with various disorders where an involvement of the hypothalamo-pituitary region was suspected; (2) obese patients; (3) specific syndromes: spontaneous hypoglycemia, anorexia nervosa, Turner’s syndrome, craniopharyngioma. Glucose, free fatty acids, cortisol and growth hormone were measured before injection of insulin, and at 20-min-intervals thereafter for a period of 2–4 h. The findings, particularly in obesity and in syndromes other than growth disorders have shown, that a series of factors have to be considered for a correct interpretation of the hormonal response to hypoglycemia. The limits for normal, reduced or absent response are given and as a simple screening for growth hormonee deficiency, a growth hormone estimation without stimulation can be used. The test has been found safe under clinical conditions and to provide reliable information about growth hormone and ACTH, respectively cortisol reaction.