{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T19:44:24Z","timestamp":1791229464512,"version":"4.1.0"},"reference-count":34,"publisher":"Oxford University Press (OUP)","issue":"2","content-domain":{"domain":["eje.bioscientifica.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2013,8]]},"abstract":"<jats:sec><jats:title>Objective<\/jats:title><jats:p>Based on adult data, a peak cortisol response \u2265500\u200anmol\/l to insulin-induced hypoglycaemia constitutes a normal. Age-specific reference ranges for basal morning cortisol have been developed for clinical use in the paediatric population. Such reference ranges are not clearly established for peak cortisol responses to insulin-induced hypoglycaemia despite limited data suggesting an effect of age on peak cortisol. The aims of this study were to assess factors affecting the cortisol response to insulin-induced hypoglycaemia in children and to determine whether the peak cortisol response was related to age.<\/jats:p><\/jats:sec><jats:sec><jats:title>Design<\/jats:title><jats:p>The present study was a retrospective cohort study.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Retrospective analysis of children and adolescents aged \u226418 years undergoing the insulin tolerance test with adequate hypoglycaemia was undertaken. Patients with hypopituitarism or severe hypothalamic\u2013pituitary\u2013adrenal axis impairment (peak cortisol value &lt;400\u200anmol\/l) or using systemic glucocorticoids were excluded.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Two hundred and twenty-three tests were analysed. Peak cortisol responses \u2265500\u200anmol\/l occurred in 183 (82%) tests. Age was negatively associated with peak cortisol responses (<jats:italic>r<\/jats:italic>=\u22120.15, <jats:italic>P<\/jats:italic>=0.03). A peak cortisol response &lt;500\u200anmol\/l was significantly less common in patients aged &lt;12 years (9\/97 (9%) vs 31\/126 (25%); <jats:italic>P<\/jats:italic>=0.004). In children aged &lt;12 years, the median (5th\u201395th centiles) peak cortisol values were 610 (480\u2013806) nmol\/l compared with 574 (442\u2013789) nmol\/l in children aged \u226512 years (<jats:italic>P<\/jats:italic>&lt;0.004). Similarly, median cortisol increment was significantly higher in younger patients (301\u200anmol\/l compared with 226\u200anmol\/l (<jats:italic>P<\/jats:italic>=0.0004)).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Use of a single peak cortisol threshold in children of all ages is not appropriate and will result in overdiagnosis of adrenal insufficiency in adolescents.<\/jats:p><\/jats:sec>","DOI":"10.1530\/eje-13-0084","type":"journal-article","created":{"date-parts":[[2013,5,15]],"date-time":"2013-05-15T04:31:18Z","timestamp":1368592278000},"page":"139-145","update-policy":"https:\/\/doi.org\/10.1530\/crossmarkpolicy-1","source":"Crossref","is-referenced-by-count":10,"title":["Requirement for age-specific peak cortisol responses to insulin-induced hypoglycaemia in children"],"prefix":"10.1093","volume":"169","author":[{"given":"Michael J","family":"O'Grady","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Conor","family":"Hensey","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Miriam","family":"Fallon","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hilary","family":"Hoey","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nuala","family":"Murphy","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Colm","family":"Costigan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Declan","family":"Cody","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","reference":[{"issue":"3","key":"1_7643827","doi-asserted-by":"crossref","first-page":"216","DOI":"10.1002\/bjs.1800560315","volume":"56","author":"Plumpton","year":"1969","journal-title":"The British journal of surgery","ISSN":"https:\/\/id.crossref.org\/issn\/0007-1323","issn-type":"print"},{"issue":"4","key":"2_15662750","doi-asserted-by":"publisher","first-page":"923","DOI":"10.1210\/jc.79.4.923","volume":"79","author":"Grinspoon","year":"1994","journal-title":"Journal of Clinical Endocrinology &amp; Metabolism","ISSN":"https:\/\/id.crossref.org\/issn\/0021-972X","issn-type":"print"},{"issue":"2","key":"3_16020309","doi-asserted-by":"crossref","first-page":"133","DOI":"10.1111\/j.1365-2265.1995.tb01907.x","volume":"43","author":"Hindmarsh","year":"1995","journal-title":"Clinical endocrinology","ISSN":"https:\/\/id.crossref.org\/issn\/0300-0664","issn-type":"print"},{"issue":"5","key":"4_12902946","doi-asserted-by":"publisher","first-page":"802","DOI":"10.1210\/jcem-40-5-802","volume":"40","author":"CACCIARI","year":"1975","journal-title":"Journal of Clinical Endocrinology &amp; Metabolism","ISSN":"https:\/\/id.crossref.org\/issn\/0021-972X","issn-type":"print"},{"issue":"1","key":"5_32167619","doi-asserted-by":"publisher","first-page":"70","DOI":"10.1530\/acta.0.0800070","volume":"80","author":"Andler","year":"1975","journal-title":"European Journal of Endocrinology","ISSN":"https:\/\/id.crossref.org\/issn\/0804-4643","issn-type":"print"},{"issue":"11","key":"6_13695198","first-page":"912","volume":"21","author":"Gil-Ad","year":"1985","journal-title":"Israel journal of medical sciences","ISSN":"https:\/\/id.crossref.org\/issn\/0021-2180","issn-type":"print"},{"issue":"3","key":"7_13260171","doi-asserted-by":"crossref","first-page":"372","DOI":"10.1111\/j.1651-2227.1994.tb17750.x","volume":"73","author":"Petersen","year":"1984","journal-title":"Acta Paediatrica Scandinavica","ISSN":"https:\/\/id.crossref.org\/issn\/0001-656X","issn-type":"print"},{"issue":"2","key":"8_18060454","doi-asserted-by":"publisher","first-page":"92","DOI":"10.1159\/000075339","volume":"61","author":"Crofton","year":"2004","journal-title":"Hormone research","ISSN":"https:\/\/id.crossref.org\/issn\/0301-0163","issn-type":"print"},{"issue":"9","key":"9_14442485","doi-asserted-by":"crossref","first-page":"1339","DOI":"10.1097\/00003246-199309000-00018","volume":"21","author":"Schultz","year":"1993","journal-title":"Critical care medicine","ISSN":"https:\/\/id.crossref.org\/issn\/0090-3493","issn-type":"print"},{"issue":"2","key":"10_14282190","doi-asserted-by":"crossref","first-page":"221","DOI":"10.1111\/j.1365-2265.1987.tb00780.x","volume":"26","author":"H\u00a0\u00a0gg","year":"1987","journal-title":"Clinical endocrinology","ISSN":"https:\/\/id.crossref.org\/issn\/0300-0664","issn-type":"print"},{"issue":"8","key":"11_14489891","first-page":"525","volume":"31","author":"Jonetz-Mentzel","year":"1993","journal-title":"European journal of clinical chemistry and clinical biochemistry : journal of the Forum of European Clinical Chemistry Societies","ISSN":"https:\/\/id.crossref.org\/issn\/0939-4974","issn-type":"print"},{"issue":"4","key":"12_12429544","first-page":"225","volume":"26","author":"Toppet","year":"1972","journal-title":"Acta paediatrica Belgica","ISSN":"https:\/\/id.crossref.org\/issn\/0001-6535","issn-type":"print"},{"issue":"10","key":"13_21798081","doi-asserted-by":"publisher","first-page":"808","DOI":"10.1136\/adc.2005.087247","volume":"91","year":"2006","journal-title":"Archives of Disease in Childhood","ISSN":"https:\/\/id.crossref.org\/issn\/0003-9888","issn-type":"print"},{"issue":"1","key":"14_5858699","doi-asserted-by":"publisher","first-page":"88","DOI":"10.1210\/jc.83.1.88","volume":"83","author":"Weintrob","year":"1998","journal-title":"Journal of Clinical Endocrinology &amp; Metabolism","ISSN":"https:\/\/id.crossref.org\/issn\/0021-972X","issn-type":"print"},{"issue":"11","key":"15_18333571","doi-asserted-by":"publisher","first-page":"1024","DOI":"10.1136\/adc.2003.043406","volume":"89","author":"Cole","year":"2004","journal-title":"Archives of Disease in Childhood","ISSN":"https:\/\/id.crossref.org\/issn\/0003-9888","issn-type":"print"},{"issue":"6","key":"16_12425547","doi-asserted-by":"crossref","first-page":"470","DOI":"10.1055\/s-0028-1094008","volume":"4","author":"Genazzani","year":"1972","journal-title":"Hormone and metabolic research. Hormon- und Stoffwechselforschung. Hormones et m&#x00A0;&#x00A0;tabolisme","ISSN":"https:\/\/id.crossref.org\/issn\/0018-5043","issn-type":"print"},{"issue":"1","key":"17_12962135","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1210\/jcem-41-1-1","volume":"41","author":"DONALD","year":"1975","journal-title":"Journal of Clinical Endocrinology &amp; Metabolism","ISSN":"https:\/\/id.crossref.org\/issn\/0021-972X","issn-type":"print"},{"issue":"7","key":"18_6075041","doi-asserted-by":"publisher","first-page":"2350","DOI":"10.1210\/jc.83.7.2350","volume":"83","author":"Erturk","year":"1998","journal-title":"Journal of Clinical Endocrinology &amp; Metabolism","ISSN":"https:\/\/id.crossref.org\/issn\/0021-972X","issn-type":"print"},{"issue":"3","key":"19_9548026","doi-asserted-by":"publisher","first-page":"674","DOI":"10.1210\/jcem-73-3-674","volume":"73","author":"LASHANSKY","year":"1991","journal-title":"Journal of Clinical Endocrinology &amp; Metabolism","ISSN":"https:\/\/id.crossref.org\/issn\/0021-972X","issn-type":"print"},{"issue":"5","key":"20_8930542","doi-asserted-by":"publisher","first-page":"931","DOI":"10.1210\/jcem-47-5-931","volume":"47","author":"FOREST","year":"1978","journal-title":"Journal of Clinical Endocrinology &amp; Metabolism","ISSN":"https:\/\/id.crossref.org\/issn\/0021-972X","issn-type":"print"},{"issue":"12","key":"21_33909906","doi-asserted-by":"publisher","first-page":"1129","DOI":"10.1515\/JPEM.2008.21.12.1129","volume":"21","author":"Mushtaq","year":"2008","journal-title":"The Journal of pediatric endocrinology","ISSN":"https:\/\/id.crossref.org\/issn\/0334-018X","issn-type":"print"},{"issue":"6","key":"22_41809013","doi-asserted-by":"crossref","first-page":"843","DOI":"10.1111\/j.1365-2265.2011.04313.x","volume":"76","author":"Corrias","year":"2012","journal-title":"Clinical endocrinology","ISSN":"https:\/\/id.crossref.org\/issn\/0300-0664","issn-type":"print"},{"issue":"2","key":"23_10424027","doi-asserted-by":"publisher","first-page":"199","DOI":"10.1046\/j.1365-2265.2000.01028.x","volume":"53","author":"Gonz\u00a0\u00a0lbez","year":"2000","journal-title":"Clinical endocrinology","ISSN":"https:\/\/id.crossref.org\/issn\/0300-0664","issn-type":"print"},{"key":"24_46078139","doi-asserted-by":"crossref","first-page":"200","DOI":"10.1159\/000320479","volume":"75","year":"2011","journal-title":"HORMONE RESEARCH IN PAEDIATRICS"},{"issue":"10","key":"25_18463511","doi-asserted-by":"publisher","first-page":"5030","DOI":"10.1210\/jc.2004-0364","volume":"89","author":"Walvoord","year":"2004","journal-title":"Journal of Clinical Endocrinology &amp; Metabolism","ISSN":"https:\/\/id.crossref.org\/issn\/0021-972X","issn-type":"print"},{"issue":"10","key":"26_10996881","doi-asserted-by":"publisher","first-page":"3648","DOI":"10.1210\/jc.84.10.3648","volume":"84","author":"Nye","year":"1999","journal-title":"Journal of Clinical Endocrinology &amp; Metabolism","ISSN":"https:\/\/id.crossref.org\/issn\/0021-972X","issn-type":"print"},{"issue":"5","key":"27_18845724","doi-asserted-by":"publisher","first-page":"735","DOI":"10.1530\/eje.1.01911","volume":"152","author":"Maghnie","year":"2005","journal-title":"European Journal of Endocrinology","ISSN":"https:\/\/id.crossref.org\/issn\/0804-4643","issn-type":"print"},{"issue":"11","key":"28_39146792","doi-asserted-by":"crossref","first-page":"1097","DOI":"10.1515\/jpem.2010.174","volume":"23","author":"Kamrath","year":"2010","journal-title":"The Journal of pediatric endocrinology","ISSN":"https:\/\/id.crossref.org\/issn\/0334-018X","issn-type":"print"},{"key":"29_46078140","doi-asserted-by":"crossref","first-page":"73","DOI":"10.1111\/j.1365-2265.2012.04474.x","volume":"78","year":"2013","journal-title":"Clinical endocrinology","ISSN":"https:\/\/id.crossref.org\/issn\/0300-0664","issn-type":"print"},{"issue":"4","key":"30_29047211","doi-asserted-by":"publisher","first-page":"E970","DOI":"10.1152\/ajpendo.00495.2006","volume":"293","year":"2007","journal-title":"American Journal of Physiology - Endocrinology And Metabolism","ISSN":"https:\/\/id.crossref.org\/issn\/0193-1849","issn-type":"print"},{"issue":"2","key":"31_35063968","doi-asserted-by":"publisher","first-page":"R515","DOI":"10.1152\/ajpregu.00200.2009","volume":"297","year":"2009","journal-title":"American Journal of Physiology - Regulatory, Integrative and Comparative Physiology","ISSN":"https:\/\/id.crossref.org\/issn\/0363-6119","issn-type":"print"},{"issue":"10","key":"32_10534367","doi-asserted-by":"publisher","first-page":"3561","DOI":"10.1210\/jc.85.10.3561","volume":"85","author":"Laughlin","year":"2000","journal-title":"Journal of Clinical Endocrinology &amp; Metabolism","ISSN":"https:\/\/id.crossref.org\/issn\/0021-972X","issn-type":"print"},{"issue":"1","key":"33_17990974","doi-asserted-by":"publisher","first-page":"281","DOI":"10.1210\/jc.2003-030440","volume":"89","author":"Purnell","year":"2004","journal-title":"Journal of Clinical Endocrinology &amp; Metabolism","ISSN":"https:\/\/id.crossref.org\/issn\/0021-972X","issn-type":"print"},{"issue":"11","key":"34_31696089","doi-asserted-by":"publisher","first-page":"4245","DOI":"10.1210\/jc.2008-0710","volume":"93","year":"2008","journal-title":"Journal of Clinical Endocrinology &amp; Metabolism","ISSN":"https:\/\/id.crossref.org\/issn\/0021-972X","issn-type":"print"}],"container-title":["European Journal of Endocrinology"],"original-title":[],"link":[{"URL":"https:\/\/eje.bioscientifica.com\/view\/journals\/eje\/169\/2\/139.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/eje.bioscientifica.com\/view\/journals\/eje\/169\/2\/139.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,2,14]],"date-time":"2023-02-14T16:29:14Z","timestamp":1676392154000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/ejendo\/article\/169\/2\/139\/6671002"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2013,8]]},"references-count":34,"journal-issue":{"issue":"2"},"URL":"https:\/\/doi.org\/10.1530\/eje-13-0084","relation":{},"ISSN":["0804-4643","1479-683X"],"issn-type":[{"value":"0804-4643","type":"print"},{"value":"1479-683X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2013,8]]}}}