{"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":1791229464682,"version":"4.1.0"},"reference-count":28,"publisher":"American Academy of Pediatrics (AAP)","issue":"3","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2008,9,1]]},"abstract":"<jats:p>OBJECTIVES. 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.<\/jats:p>\n               <jats:p>STUDY DESIGN. 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 \u22657.5 ng\/mL, and a normal cortisol level was defined as \u226518 \u03bcg\/dL.<\/jats:p>\n               <jats:p>RESULTS. During the fasting tests, 84 children (median age: 1.3 years [2 days to 14.3 years]), became hypoglycemic, with blood glucose \u226450 mg\/dL. Diagnoses included normal, ketotic hypoglycemia, hyperinsulinism, fatty acid\u2013oxidation defects, glycogen-storage disease, and late dumping hypoglycemia. A total of 70% had growth hormone and cortisol levels less than the \u201cnormal\u201d thresholds regardless of diagnosis. Of various factors (age, diagnosis, fast duration, duration blood glucose level of &amp;lt;60 mg\/dL, and blood glucose nadir), only age was positively associated with cortisol, and none were consistently related to growth hormone.<\/jats:p>\n               <jats:p>CONCLUSIONS. 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.<\/jats:p>","DOI":"10.1542\/peds.2008-0806","type":"journal-article","created":{"date-parts":[[2008,8,12]],"date-time":"2008-08-12T00:25:00Z","timestamp":1218500700000},"page":"e522-e528","source":"Crossref","is-referenced-by-count":52,"title":["Poor Specificity of Low Growth Hormone and Cortisol Levels During Fasting Hypoglycemia for the Diagnoses of Growth Hormone Deficiency and Adrenal Insufficiency"],"prefix":"10.1542","volume":"122","author":[{"given":"Andrea","family":"Kelly","sequence":"first","affiliation":[{"name":"Division of Endocrinology\/Diabetes, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania"},{"name":"Department of Pediatrics, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Randy","family":"Tang","sequence":"additional","affiliation":[{"name":"Division of Endocrinology\/Diabetes, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Susan","family":"Becker","sequence":"additional","affiliation":[{"name":"Division of Endocrinology\/Diabetes, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Charles A.","family":"Stanley","sequence":"additional","affiliation":[{"name":"Division of Endocrinology\/Diabetes, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania"},{"name":"Department of Pediatrics, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"417","published-online":{"date-parts":[[2008,9,1]]},"reference":[{"key":"2021120905235880500_R1","doi-asserted-by":"crossref","unstructured":"Pagliara A, Karl I, DeVivo D, Feigin R, Kipnis D. Hypoalaninemia: a concomitant of ketotic hypoglycemia. J Clin Invest.\u20081972;51(6):1440\u20131449","DOI":"10.1172\/JCI106940"},{"key":"2021120905235880500_R2","doi-asserted-by":"crossref","unstructured":"Nitzan M, Kowadlo-Silbergeld A, Doron M, Laron Z. Metabolic substrates and hormones during starvation ketosis in children. Am J Clin Nutr.\u20081968;21(11):1268\u20131273","DOI":"10.1093\/ajcn\/21.11.1268"},{"key":"2021120905235880500_R3","doi-asserted-by":"crossref","unstructured":"Chaussain J, Georges P, Olive G, Job J. Glycemic response to 24-hour fast in normal children and children with ketotic hypoglycemia: II. Hormonal and metabolic changes. J Pediatr.\u20081974;85(6):776\u2013781","DOI":"10.1016\/S0022-3476(74)80339-2"},{"key":"2021120905235880500_R4","doi-asserted-by":"crossref","unstructured":"Kaye R, Davidson MH, Williams ML. The response of blood glucose, ketones, and plasma nonesterified fatty acids to fasting and epinephrine injection in infants and children. J Pediatr.\u20081961;59:836\u2013847","DOI":"10.1016\/S0022-3476(61)80314-4"},{"key":"2021120905235880500_R5","doi-asserted-by":"crossref","unstructured":"Cahill GF. Starvation in man. N Engl J Med.\u20081970;282(12):668\u2013675","DOI":"10.1056\/NEJM197003192821209"},{"key":"2021120905235880500_R6","doi-asserted-by":"crossref","unstructured":"Cahill GF, Herrera MG, Morgan AP, et al. Hormone-fuel interrelationships during fasting. J Clin Invest.\u20081966;45(11):1751\u20131769","DOI":"10.1172\/JCI105481"},{"key":"2021120905235880500_R7","doi-asserted-by":"crossref","unstructured":"Stanley CA, Baker L. Hyperinsulinism in infancy: diagnosis by demonstration of abnormal response to fasting hypoglycemia. Pediatrics.\u20081976;57(5):702\u2013711","DOI":"10.1542\/peds.57.5.702"},{"key":"2021120905235880500_R8","doi-asserted-by":"crossref","unstructured":"Baker L, Winegrad AI. Fasting hypoglycemia and metabolic acidosis associated with deficiency of hepatic fructose-1,6-diphosphatase activity. Lancet.\u20081970;2(7662):13\u201316","DOI":"10.1016\/S0140-6736(70)92474-8"},{"key":"2021120905235880500_R9","doi-asserted-by":"crossref","unstructured":"Finegold DN, Stanley CA, Baker L. Glycemic response to glucagon during fasting hypoglycemia: an aid in the diagnosis of hyperinsulinism. J Pediatr.\u20081980;96(2):257\u2013259","DOI":"10.1016\/S0022-3476(80)80817-1"},{"key":"2021120905235880500_R10","unstructured":"Stanley CA, Baker L. Hypoglycemia. In: Kaye R, Oski FA, Barness LA, eds. Core Textbook of Pediatrics. Philadelphia, PA: J.B. Lippincott Co; 1978:280\u2013305"},{"key":"2021120905235880500_R11","doi-asserted-by":"crossref","unstructured":"Roth J, Glick S, Yalow R, Berson S. Hypoglycemia: a potent stimulus to secretion of growth hormone. Science.\u20081963;140:987\u2013988","DOI":"10.1126\/science.140.3570.987"},{"key":"2021120905235880500_R12","doi-asserted-by":"crossref","unstructured":"Greenwood FC, Landon J, Stamp CB. The plasma sugar, free fatty acid, cortisol, and growth hormone response to insulin: I. In control subjects. J Clin Invest.\u20081966;45(4):429\u2013436","DOI":"10.1172\/JCI105357"},{"key":"2021120905235880500_R13","doi-asserted-by":"crossref","unstructured":"Landon J, Greenwood FC, Stamp TC, Wynn V. The plasma sugar, free fatty acid, cortisol, and growth hormone response to insulin, and the comparison of this procedure with other tests of pituitary and adrenal function: II. In patients with hypothalamic or pituitary dysfunction or anorexia nervosa. J Clin Invest.\u20081966;45(4):437\u2013449","DOI":"10.1172\/JCI105358"},{"key":"2021120905235880500_R14","doi-asserted-by":"crossref","unstructured":"Growth Hormone Research Society. Consensus guidelines for the diagnosis and treatment of growth hormone (GH) deficiency in childhood and adolescence: summary statement of the GH Research Society. GH Research Society. J Clin Endocrinol Metab.\u20082000;85(11):3990\u20133993","DOI":"10.1210\/jc.85.11.3990"},{"key":"2021120905235880500_R15","doi-asserted-by":"crossref","unstructured":"Ogilvy-Stuart AL. Growth hormone deficiency (GHD) from birth to 2 years of age: diagnostic specifics of GHD during the early phase of life. Horm Res.\u20082003;60(suppl 1):2\u20139","DOI":"10.1159\/000071219"},{"key":"2021120905235880500_R16","doi-asserted-by":"crossref","unstructured":"Ranke M. Diagnosis of growth hormone deficiency and growth hormone stimulation tests. In: Ranke M, ed. Diagnostics of Endocrine Function in Children and Adolescents. Basel, Switzerland: Karger; 2003:107\u2013128","DOI":"10.1159\/000073547"},{"key":"2021120905235880500_R17","doi-asserted-by":"crossref","unstructured":"Forest M. Adrenal function tests. In: Ranke M, ed. Diagnostics of Endocrine Function in Children and Adolescents. Basel, Switzerland: Karger;2003:372\u2013426","DOI":"10.1159\/000073560"},{"key":"2021120905235880500_R18","doi-asserted-by":"crossref","unstructured":"Lindholm J, Kehlet H, Blichert-Toft M, Dinesen B, Riishede J. Reliability of the 30-minute ACTH test in assessing hypothalamic-pituitary-adrenal function. J Clin Endocrinol Metab.\u20081978;47(2):272\u2013274","DOI":"10.1210\/jcem-47-2-272"},{"key":"2021120905235880500_R19","doi-asserted-by":"crossref","unstructured":"Abdu TA, Elhadd TA, Neary R, Clayton RN. Comparison of the low dose short synacthen test (1 microg), the conventional dose short synacthen test (250 microg), and the insulin tolerance test for assessment of the hypothalamo-pituitary-adrenal axis in patients with pituitary disease. J Clin Endocrinol Metab.\u20081999;84(3):838\u2013843","DOI":"10.1210\/jcem.84.3.5535"},{"key":"2021120905235880500_R20","doi-asserted-by":"crossref","unstructured":"Stewart PM, Corrie J, Seckl JR, Edwards CR, Padfield PL. A rational approach for assessing the hypothalamo-pituitary-adrenal axis. Lancet.\u20081988;1(8596):1208\u20131210","DOI":"10.1016\/S0140-6736(88)92020-X"},{"key":"2021120905235880500_R21","doi-asserted-by":"crossref","unstructured":"Miller JD, Esparza A, Wright NM, et al. Spontaneous growth hormone release in term infants: changes during the first four days of life. J Clin Endocrinol Metab.\u20081993;76(4):1058\u20131062","DOI":"10.1210\/jc.76.4.1058"},{"key":"2021120905235880500_R22","doi-asserted-by":"crossref","unstructured":"Ogilvy-Stuart AL, Hands SJ, Adcock CJ, et al. Insulin, insulin-like growth factor I (IGF-I), IGF-binding protein-1, growth hormone, and feeding in the newborn. J Clin Endocrinol Metab.\u20081998;83(10):3550\u20133557","DOI":"10.1210\/jcem.83.10.5162"},{"key":"2021120905235880500_R23","doi-asserted-by":"crossref","unstructured":"Kaplan SL, Grumbach MM, Shepard TH. The ontogenesis of human fetal hormones: I. Growth hormone and insulin. J Clin Invest.\u20081972;51(12):3080\u20133093","DOI":"10.1172\/JCI107135"},{"key":"2021120905235880500_R24","doi-asserted-by":"crossref","unstructured":"Chanoine JP, Rebuffat E, Kahn A, Bergmann P, Van Vliet G. Glucose, growth hormone, cortisol, and insulin responses to glucagon injection in normal infants, aged 0.5\u201312 months. J Clin Endocrinol Metab.\u20081995;80(10):3032\u20133035","DOI":"10.1210\/jcem.80.10.7559892"},{"key":"2021120905235880500_R25","doi-asserted-by":"crossref","unstructured":"Hussain K, Hindmarsh P, Aynsley-Green A. Neonates with symptomatic hyperinsulinemic hypoglycemia generate inappropriately low serum cortisol counterregulatory hormonal responses. J Clin Endocrinol Metab.\u20082003;88(9):4342\u20134347","DOI":"10.1210\/jc.2003-030135"},{"key":"2021120905235880500_R26","doi-asserted-by":"crossref","unstructured":"Beitins IZ, Kowarski A, Migeon CJ, Graham GG. Adrenal function in normal infants and in marasmus and kwashiorkor: cortisol secretion, diurnal variation of plasma cortisol, and urinary excretion of 17-hydroxycorticoids, free corticoids, and cortisol. J Pediatr.\u20081975;86(2):302\u2013308","DOI":"10.1016\/S0022-3476(75)80495-1"},{"key":"2021120905235880500_R27","doi-asserted-by":"crossref","unstructured":"Crofton P, Don-Wauchope A, Bath L, Kelnar C. Cortisol responses to the insulin hypoglycaemia test in children. Horm Res.\u20082004;61(2):92\u201397","DOI":"10.1159\/000075339"},{"key":"2021120905235880500_R28","doi-asserted-by":"crossref","unstructured":"Hussain K, Hindmarsh P, Aynsley-Green A. Spontaneous hypoglycemia in childhood is accompanied by paradoxically low serum growth hormone and appropriate cortisol counterregulatory hormonal responses. J Clin Endocrinol Metab.\u20082003;88(8):3715\u20133723","DOI":"10.1210\/jc.2003-030137"}],"container-title":["Pediatrics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/publications.aap.org\/pediatrics\/article-pdf\/122\/3\/e522\/1175556\/zpe0090800e522.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/publications.aap.org\/pediatrics\/article-pdf\/122\/3\/e522\/1175556\/zpe0090800e522.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,12,9]],"date-time":"2021-12-09T22:50:00Z","timestamp":1639090200000},"score":1,"resource":{"primary":{"URL":"https:\/\/publications.aap.org\/pediatrics\/article\/122\/3\/e522\/72253\/Poor-Specificity-of-Low-Growth-Hormone-and"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2008,9,1]]},"references-count":28,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2008,9,1]]},"published-print":{"date-parts":[[2008,9,1]]}},"URL":"https:\/\/doi.org\/10.1542\/peds.2008-0806","relation":{},"ISSN":["0031-4005","1098-4275"],"issn-type":[{"value":"0031-4005","type":"print"},{"value":"1098-4275","type":"electronic"}],"subject":[],"published":{"date-parts":[[2008,9,1]]}}}