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High Risk of Adrenal Insufficiency in Adults Previously Treated for Idiopathic Childhood Onset Growth Hormone Deficiency

Department of Endocrinology (M.L., U.F.-R., O.L.S.), Rigshospitalet, DK-2100 Copenhagen, Denmark; Department of Paediatrics (K.W.K.), Glostrup County Hospital, DK-2600 Glostrup, Denmark; and Department of Growth and Reproduction (A.J., J.M.), Rigshospitalet, DK-2100 Copenhagen, Denmark

Address all correspondence and requests for reprints to: Martin Lange, Department of Endocrinology, Rigshospitalet, Blegdamsvej 9, DK-2100 Copenhagen, Denmark. E-mail: mlange{at}rh.dk.

The aim was to reevaluate a group of adults treated for idiopathic childhood onset GH deficiency (GHD) after 18 yr without GH treatment.

Twenty-six (11 females) patients participated. All but two had isolated GHD. Childhood diagnosis was established by insulin tolerance test (ITT). The patients were retested with an ITT to evaluate adult GH status. In five patients, an arginine and a synacthen test were performed instead of an ITT.

Eleven of 25 patients had a subnormal cortisol response to ITT or synacthen. Ten patients had a GH peak less than 3.0 µg/liter (0.5. ± 0.5 µg/liter), whereas 16 patients displayed a normal GH response (12.3 ± 10.6 µg/liter) after ITT. IGF-I values were decreased in the patients with a pathological retest as well as in patients with a normal GH response compared with controls (P < 0.005).

In 26 idiopathic childhood onset GHD patients, 44% of the patients had developed adrenal insufficiency; 38.5% had persistent GHD in adulthood, using the same test in both childhood and adulthood. Patients having a normal GH test had decreased IGF-I levels, compared with controls, indicating impaired function of a seemingly normal GH axis. It is imperative that pituitary axes other than the GH axis are tested at regular intervals, even in the absence of GHD in adulthood.

This study was supported by Grant no. 22-00-0349 from the Danish Medical Research Council.

Abbreviations: BMI, Body mass index; CO, childhood onset; CV, coefficient of variation; GHD, GH deficiency; ITT, insulin tolerance test; SDS, SD score.

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