Kelly Andrea, Tang Randy, Becker Susan, Stanley Charles A
Children's Hospital of Philadelphia, University of Pennsylvania School of Medicine, Division of Endocrinology/Diabetes, 8416 Main Building, 34th and Civic Center Boulevard, Philadelphia, PA 19104, USA.
Pediatrics. 2008 Sep;122(3):e522-8. doi: 10.1542/peds.2008-0806. Epub 2008 Aug 11.
Fasting tests are used to identify the cause of hypoglycemia in children. The purposes of this study were to (1) determine whether growth hormone and cortisol levels obtained at the time of hypoglycemia in such tests can identify children with growth hormone and/or cortisol deficiency and (2) identify potential clinical factors that influence growth hormone and cortisol responses to hypoglycemia.
The design consisted of chart review of all diagnostic fasting tests conducted over a 3-year period (n = 151). A normal growth hormone level was defined as >/=7.5 ng/mL, and a normal cortisol level was defined as >/=18 mug/dL.
During the fasting tests, 84 children (median age: 1.3 years [2 days to 14.3 years]), became hypoglycemic, with blood glucose </=50 mg/dL. Diagnoses included normal, ketotic hypoglycemia, hyperinsulinism, fatty acid-oxidation defects, glycogen-storage disease, and late dumping hypoglycemia. A total of 70% had growth hormone and cortisol levels less than the "normal" thresholds regardless of diagnosis. Of various factors (age, diagnosis, fast duration, duration blood glucose level of <60 mg/dL, and blood glucose nadir), only age was positively associated with cortisol, and none were consistently related to growth hormone.
A singe low growth hormone or cortisol value at the time of fasting hypoglycemia has poor specificity for the respective diagnoses of growth hormone deficiency and adrenal insufficiency.
空腹试验用于确定儿童低血糖的病因。本研究的目的是：（1）确定在此类试验中低血糖发生时所测得的生长激素和皮质醇水平是否能识别出生长激素和/或皮质醇缺乏的儿童；（2）识别影响生长激素和皮质醇对低血糖反应的潜在临床因素。
研究设计包括对3年期间进行的所有诊断性空腹试验（n = 151）进行病历回顾。正常生长激素水平定义为≥7.5 ng/mL，正常皮质醇水平定义为≥18 μg/dL。
在空腹试验期间，84名儿童（中位年龄：1.3岁[2天至14.3岁]）出现低血糖，血糖≤50 mg/dL。诊断包括正常、酮症性低血糖、高胰岛素血症、脂肪酸氧化缺陷、糖原贮积病和晚期倾倒性低血糖。无论诊断如何，共有70%的儿童生长激素和皮质醇水平低于“正常”阈值。在各种因素（年龄、诊断、禁食持续时间、血糖水平<60 mg/dL的持续时间以及血糖最低点）中，只有年龄与皮质醇呈正相关，且没有一个因素与生长激素始终相关。
空腹低血糖时单次生长激素或皮质醇值低，对生长激素缺乏和肾上腺功能不全各自的诊断特异性较差。
