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Hypocortisolemia in Children Undergoing Evaluation for Growth Hormone Deficiency^*

Department of Pediatrics, University of Maryland School of Medicine (S.A.C., A.A.K.) Baltimore, Maryland 21201
Department of Pediatrics, Kaplan Hospital (Z.Z.) Rehouot, Israel

Address all correspondence and requests for reprints to: S. A. Chalew, M.D., University of Maryland School of Medicine, 10-047 Bressler Research Building, Baltimore, Maryland 21201.

The group of children who have clinical manifestations of GH deficiency may potentially contain a large number of patients with secretory defects of cortisol. We assessed physiological cortisol secretion by measuring the 24-h integrated concentration of cortisol (IC-F) in a series of 105 patients, aged 7–19 yr, undergoing endocrinological evaluation for growth impairment possibly due to GH deficiency.

The reference value for IC-F, established from 30 normal stature, normal weight children (controls), aged 7–18 yr, was 157 ± 41 nmol/L (mean ± 1 SD). There was no effect of age, gender, or pubertal status on IC-F in controls.

The IC-F of patients was 150 ± 72 nmol/L. Twelve patients (11%) had IC-F values more than 2 SD below the mean (i.e. <75 nmol/L) of the controls (P < 0.001). An IC-F below 75 nmol/L was associated with a blunted peak cortisol response to insulininduced hypoglycemia (367 ± 160 nmol/L compared to 464 ± 155 nmol/L in the other patients; (P < 0.05). None of the patients had obvious clinical symptoms of hypocortisolemia at the time of testing.

In general, IC-F levels were not correlated with IC-GH. However, 10 patients who had subnormal IC-F values also had laboratory evidence of GH secretory defects; 7 had subnormal IC-GH levels but normal stimulated GH responses, and 3 had both subnormal responses to stimulation as well as subnormal IC-GH.

The long term prognosis and management implications of hypocortisolemia diagnosed in this patient group require further evaluation.

^* This research was supported in part by the Edward Rogers Memorial Fund. Presented in part at the 71st Annual Meeting of The Endocrine Society, Seattle, WA, June 1989.

Received October 10, 1989.