Journal of Endocrinological Investigation

, Volume 27, Issue 11, pp 1060–1064 | Cite as

A rare case of adulthood-onset growth hormone deficiency presenting as sporadic, symptomatic hypoglycemia

  • A. Pia
  • A. Piovesan
  • F. Tassone
  • P. Razzore
  • G. Visconti
  • G. Magro
  • F. Cesario
  • M. Terzolo
  • G. Borretta
Case Report


Symptomatic hypoglycemia is described in children with severe GH deficiency (GHD), but is rare in adults with GHD. We describe the case of a 62- yr-old man, referred for recurrent hypoglycemic events. He reported a previous head trauma at the age of 20 yr and a diagnosis of reactive hypoglycemia at the age of 50 yr. In the last months, during a period of job-related stress, the hypoglycemic episodes became more frequent and severe (glucose <2.2 mmol/l), finally requiring hospitalization. On admission, the patient was in good general health, with normal renal and hepatic function. During hospitalization, no hypoglycemic episodes were recorded, also during a 72-h fasting test. Biochemical data and abdominal computed tomography (CT) excluded insulinoma. A tumor-induced hypoglycemia was ruled out. The 4-h oral glucose tolerance test (OGTT) showed an impaired glucose tolerance with a tendency toward asymptomatic hypoglycemia. Hormonal study disclosed low levels of GH (0.2 ng/ml) and IGF-I (51 ng/ml); the response of GH to GHRH plus arginine confirmed a severe GHD (GH peak 2.7 ng/ml). Other pituitary and counterregulation hormones were within the normal range and magnetic resonance imaging (MRI) of the pituitary gland was normal. Replacement therapy with a low dose of rhGH induced an increase of IGF-I up to low-normal values, accompanied by lasting regression of hypoglycemic events. In conclusion, hypoglycemia was the main clinical symptom of isolated adult onset GHD, in the present case. The possible pathogenesis of isolated adult onset GHD and the association of GHD with conditions predisposing to hypoglycemia are considered and discussed.


Hypoglycemia adult-onset GHD head trauma rhGH therapy 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    De Boer H, Blok GJ, Van der Veen EA. Clinical aspects of growth hormone deficiency in adults. Endocr Rev 1995, 16: 63–86.PubMedCrossRefGoogle Scholar
  2. 2.
    McCallum RW, Petrie JR, Dominiczak AF, Connell JM. Growth hormone deficiency and vascular risk. Clin Endocrinol (Oxf) 2002, 57: 11–24.CrossRefGoogle Scholar
  3. 3.
    Virally ML, Guillausseau PJ. Hypoglycemia in adults. Diabetes Metab 1999, 25: 477–90.PubMedGoogle Scholar
  4. 4.
    Merimee TJ, Felig P, Marliss E, Fineberg SE, Cahill GC. Glucose and lipid homeostasis in the absence of human growth hormone. J Clin Invest 1971, 50: 574–82.PubMedCentralPubMedCrossRefGoogle Scholar
  5. 5.
    Cuneo RC, Saloman F, McGauley GA, SonKsen PH. The growth hormone deficiency syndrome in adults. Clin Endocrinol (Oxf) 1992, 37: 387–97.CrossRefGoogle Scholar
  6. 6.
    Hew FL, Koschmann M, Christopher M, et al. Insulin resistance in growth hormone-deficient adults: defects in glucose utilization and glycogen synthase activity. J Clin Endocrinol Metab 1996, 81: 555–64.PubMedGoogle Scholar
  7. 7.
    Procopio M, Magro G, Cesario F, et al. The oral glucose tolerance test reveals a high frequency of both impaired glucose tolerance and undiagnosed type 2 diabetes mellitus in primary hyperparathyroidism. Diabet Med 2002, 19: 958–61.PubMedCrossRefGoogle Scholar
  8. 8.
    Christ ER, Carrol PV, Sonksen PH. Adult growth hormone deficiency. In: Wass JAH, Shalet SM eds. Oxford Textbook of Endocrinology and Diabetes. New York: Oxford University Press. 2002, 151–60.Google Scholar
  9. 9.
    Zung A, Andrews-Murray G, Winqvist O, Chalew SA. Growth hormone deficiency in autoimmune polyglandular syndrome. J Pediatr Endocrinol Metab 1997, 10: 69–72.PubMedCrossRefGoogle Scholar
  10. 10.
    Eichler I, Frisch H, Eichler HG, Soukop W. Isolated growth hormone deficiency after severe head trauma. J Endocrinol Invest 1988, 11: 409–11.PubMedCrossRefGoogle Scholar
  11. 11.
    Benvenga S, Campenni A, Ruggeri RM, Trimarchi F. Hypopituitarism secondary to head trauma. J Clin Endocrinol Metab 2000, 85: 1353–61.PubMedCrossRefGoogle Scholar
  12. 12.
    Aimaretti G, Corneli G, Razzore P, et al. Comparison between insulin-induced hypoglycemia and growth hormone (GH)-releasing hormone + arginine as provocative tests for the diagnosis of GH deficiency in adults. J Clin Endocrinol Metab 1998, 83: 1615–8.PubMedGoogle Scholar
  13. 13.
    Ron D, Powers AC, Pandian MR, Godine JE, Axelrod L. Increased insulin-like growth factor II production and consequent suppression of growth hormone secretion: a dual mechanism for tumor-induced hypoglycemia. J Clin Endocrinol Metab 1989, 68: 701–6.PubMedCrossRefGoogle Scholar
  14. 14.
    FuKui M, Nakamura S, Sato H, Matsumoto T, Nakamura N, Kondo M. Severe and recurrent fasting hypoglycemia due to growth hormone deficiency? Arch Intern Med 1999, 159: 1954–6.PubMedCrossRefGoogle Scholar
  15. 15.
    Cryer PE, Polonsky KS. Glucose homeostasis and hypoglycemia. In: Wilson JD, Foster DW eds. Williams Textbook of Endocrinology. Philadelphia: W.B. Sauders. 1998, 939–71.Google Scholar
  16. 16.
    Moller N, Jorgensen JO, Abildgard N, Orskov L, Schmitz O, Christiansen JS. Effects of growth hormone on glucose metabolism. Horm Res 1991, 36: 32–5.PubMedGoogle Scholar
  17. 17.
    Bolli GB, Fanelli CG. Physiology of glucose counterregulation to hypoglycemia. Endocrinol Metab Clin North Am 1999, 28: 467–93.PubMedCrossRefGoogle Scholar
  18. 18.
    Johansson JO, Fowelin J, Landin K, Lager I, Bengtsson BA. Growth hormone-deficient adults are insulin-resistant. Metabolism 1995, 44: 1126–9.PubMedCrossRefGoogle Scholar
  19. 19.
    Jorgensen JOL, Norrelund H, Coceicao F, Moller N, Christiansen S. Somatropin and glucose homeostasis. Considerations for Patient Management. Treat Endocrinol 2002, 1: 229–34.PubMedCrossRefGoogle Scholar
  20. 20.
    Barreto-Filho JA, Alcantara MR, Salvatori R, et al. Familial isolated growth hormone deficiency is associated with increased systolic blood pressure, central obesity, and dyslipidemia. J Clin Endocrinol Metab 2002, 87: 2018–23.PubMedCrossRefGoogle Scholar
  21. 21.
    Christ ER, Simpson HL, Breen L, Sonksen PH, Russell-Jones DL, Kohner EM. The effect of growth hormone (GH) replacement therapy in adult patients with type 1 diabetes mellitus and GH deficiency. Clin Endocrinol (Oxf) 2003, 58: 309–15.CrossRefGoogle Scholar
  22. 22.
    Salomon F, Cuneo RC, Umpleby AM, Sonksen PH. Glucose and fat metabolism in adults with growth hormone deficiency. Clin Endocrinol(Oxf) 1994, 41: 315–22.CrossRefGoogle Scholar
  23. 23.
    Rossetti L, Lee YT, Riniz J, Aldridge SC, Shamoon H, Boden G. Quantitation of glycolysis and skeletal muscle glycogen synthesis in humans. Am J Physiol 1993, 265: E761–E769.PubMedGoogle Scholar
  24. 24.
    Matsuda M, DeFronzo RA. Insulin sensitivity indices obtained from oral glucose tolerance testing: comparison with the euglycemic insulin clamp. Diabetes Care 1999, 22: 1462–70.PubMedCrossRefGoogle Scholar
  25. 25.
    Jorgensen JO, Norrelund H, Vahl N, Juul A, Skakkebaek NE, Christiansen JS. Continuation of growth hormone therapy versus placebo in transition-phase patients with growth hormone deficiency: impact on body composition, insulin sensitivity, and thyroid function. J Pediatr Endocrinol Metab 2002, 15: 1355–60.PubMedGoogle Scholar
  26. 26.
    Eden Engstrom B, Burman P, Holdstock C, Karlsson FA. Effects of growth hormone (GH) on ghrelin, leptin, and adiponectin in GH-deficient patients. J Clin Endocrinol Metab 2003, 88: 5193–98.PubMedCrossRefGoogle Scholar
  27. 27.
    Hartman ML, Crowe BJ, Biller BM, Ho KK, Clemmons DR, Chipman JJ. Which patients do not require a GH stimulation test for the diagnosis of adult GH deficiency? J Clin Endocrinol Metab 2002, 87: 477–85.PubMedCrossRefGoogle Scholar

Copyright information

© Italian Society of Endocrinology (SIE) 2004

Authors and Affiliations

  • A. Pia
    • 1
  • A. Piovesan
    • 1
  • F. Tassone
    • 1
  • P. Razzore
    • 1
  • G. Visconti
    • 2
  • G. Magro
    • 1
  • F. Cesario
    • 1
  • M. Terzolo
    • 3
  • G. Borretta
    • 1
  1. 1.Division of Endocrinology and MetabolismS. CroceCuneoItaly
  2. 2.Department of Laboratory MedicineS. CroceCuneoItaly
  3. 3.General Medical ClinicUniversity of Turin, S. LuigiOrbassano, TurinItaly

Personalised recommendations