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Persistent severe hypoglycemia due to growth hormone deficiency
Introduction. In children, persistent hypoglycemia has a major negative impact on structural and functional brain development. In infants, hypoglycemia may be the presenting feature of growth hormone (GH) deficiency.
Aim. We present the outcome of GH substitution in a girl with persistent severe hypoglycemia since infancy.
Material and methods. The child was admitted in our clinic at age three in order to establish the etiology and proper treatment of the hypoglycemia. We assessed growth, as well as the biological and hormonal profile, until the presentation in our clinic. In addition to anthropometric measurements, we obtained repeated metabolic and hormonal serum tests, a GH stimulation test with arginine, bone age X-ray. Interpreting the results was difficult considering the long time treatment with prednisone (2 years and 6 months), started at the onset of the hypoglycemia.
Results. We established that the persistent severe hypoglycemia was due to GH deficiency and started recombinant human growth hormone (rhGH) substitution. The outcome was spectacular in terms of symptoms, anthropometric, biological and hormonal profile.
Conclusions. The etiologic diagnosis of persistent severe hypoglycemia is difficult and requires an extensive approach. In this case, the certainty of the diagnosis was established by the spectacular outcome on rhGH substitution.
Key words: persistent hypoglycemia, GH defi ciency, rhGH