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April 1971, Vol 121, No. 4 >
Article | April 1971

Hypopituitarism and Ketotic Hypoglycemia FREE

Thomas F. Roe, MD; Maurice D. Kogut, MD
[+] Author Affiliations

Received for publication March 25, 1970.

Reprint requests to 4650 Sunset Blvd, Los Angeles 90054 (Dr. Roe).


Am J Dis Child. 1971;121(4):296-299. doi:10.1001/archpedi.1971.02100150070006.
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A 7-year-old patient presented with growth failure and early morning convulsions. The convulsions were associated with hypoglycemia and ketosis. Symptomatic hypoglycemia with ketosis occurred following the administration of a hypocaloric ketogenic diet. The diagnosis of hypopituitarism was established by failure of growth hormone response following administration of insulin and arginine hydrochloride, and failure of metyrapone to increase the urinary excretion of 17-ketogenic steroids. Thyroid function became abnormal. Therapy with thyroid extract alone and later combined with prednisone failed to decrease the frequency of ketotic hypoglycemic episodes. The administration of thyroid extract and human growth hormone, however, was followed by remarkable improvement which may have been due, in part, to increased insulin production.

REFERENCES

1 +
Colle E, Ulstrom RA:  Ketotic hypoglycemia . J Pediat 64:632-651, 1964;.
2 +
Kogut MD, Blaskovics M, Donnell GN:  Idiopathic hypoglycemia: A study of 26 children . J Pediat 74:853-871, 1969;.
3 +
Kogut MD, Donnell GN, Ling SM, et al:  Hypopituitarism and diabetes mellitus: Effect of human growth hormone . Pediatrics 41:905-916, 1968;.
4 +
Hugget ASG, Nixon DA:  Use of glucose oxidase, peroxidase and o-dianisidine in determination of blood and urinary glucose . Lancet 2:368-370, 1957;.
5 +
Dole VP:  A relation between non-esterified fatty acids in plasma and the metabolism of glucose . J Clin Invest 35:150-154, 1956;.
6 +
Morgan CR, Lazarow A:  Immunoassay of insulin: Two antibody system: Plasma insulin levels of normal, subdiabetic and diabetic rats . Diabetes 12:115-126, 1963;.
7 +
Glick SM, Roth J, Yalow RS, et al:  Immunoassay of human growth hormone in plasma . Nature 199:784-787, 1963;.
8 +
Goodman HG, Grumbach MM, Kaplan SL:  Growth and growth hormone: II. A comparison of isolated growth-hormone deficiency and multiple pituitary-hormone deficiencies in 35 patients with idiopathic hypopituitary dwarfism . New Eng J Med 278:57-68, 1968;.
9 +
Werner SC: The Thyroid , ed 2. New York, Harper & Row Publishers Inc, 1962;, p 809.
10 +
Nadler H, Neumann LL, Gershberg H:  Hypoglycemia, growth retardation and probable isolated growth hormone deficiency in a 1-year-old child . J Pediat 63:977-983, 1963;.
11 +
Wilber JF, Odell WD:  Hypoglycemia and dwarfism associated with the isolated deficiency of growth hormone . Metabolism 14:590-597, 1965;.
12 +
Brasel JA, Wright JC, Wilkins L, et al:  An evaluation of 75 patients with hypopituitarism beginning in childhood . Amer J Med 38:484-498, 1965;.
13 +
Beck JC, McGarry EE, Dyrenfurth I, et al:  Primate growth hormone studies in man . Metabolism 9:699-737, 1960;.
14 +
Stamp TCB:  Plasma non-esterified fatty acid levels in hypopituitary subjects . J Endocr 35:107-115, 1966;.
15 +
Raben MS, Hollenberg CH:  Effect of growth hormone on plasma fatty acids . J Clin Invest 38:484-488, 1959;.
16 +
Ikkos D, Luft R, Gemzell CA:  The effect of human growth hormone in man . Lancet 1:720-721, 1958;.
17 +
Luft R, Ikkos D, Gemzell CA, et al:  Effect of human growth hormone in hypophysectomized diabetic subjects . Lancet 1:721-722, 1958;.
18 +
Senior B, Loridan L:  Gluconeogenesis and insulin in the ketotic variety of childhood hypoglycemia and in control children . J Pediat 74:529-539, 1969;.
19 +
Steiner MM, Boggs JD:  Absence of pituitary gland, hypothyroidism, hypoadrenalism and hypogonadism in a 17-year-old dwarf . J Clin Endocr 25:1591-1598, 1965;.
20 +
Madison LL, Combes B, Adams R, et al:  The physiological significance of the secretion of endogenous insulin into the portal circulation: III. Evidence for a direct immediate effect of insulin on the balance of glucose across the liver . J Clin Invest 39:507-522, 1960;.
21 +
Drash A, Wolff F, Langs H, et al:  Diazoxide induced diabetes mellitus in a hypopituitary dwarf . Diabetes 15:319-322, 1966;.
22 +
Fajans SS, Floyd JC Jr, Knopf RF, et al:  Benzothiadiazine suppression of insulin release from normal and abnormal islet tissue in man . J Clin Invest 45:481-492, 1966;.
23 +
Luft R, Cerasi E:  Effect of human growth hormone on insulin production in panhypopituitarism . Lancet 2:124-126, 1964;.
24 +
Gold H, Spector S, Samaan NA, et al:  Effect of growth hormone on the carbohydrate metabolism in hypopituitary dwarfs . Metabolism 17:74-83, 1968;.

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Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature

Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal

References

1 +
Colle E, Ulstrom RA:  Ketotic hypoglycemia . J Pediat 64:632-651, 1964;.
2 +
Kogut MD, Blaskovics M, Donnell GN:  Idiopathic hypoglycemia: A study of 26 children . J Pediat 74:853-871, 1969;.
3 +
Kogut MD, Donnell GN, Ling SM, et al:  Hypopituitarism and diabetes mellitus: Effect of human growth hormone . Pediatrics 41:905-916, 1968;.
4 +
Hugget ASG, Nixon DA:  Use of glucose oxidase, peroxidase and o-dianisidine in determination of blood and urinary glucose . Lancet 2:368-370, 1957;.
5 +
Dole VP:  A relation between non-esterified fatty acids in plasma and the metabolism of glucose . J Clin Invest 35:150-154, 1956;.
6 +
Morgan CR, Lazarow A:  Immunoassay of insulin: Two antibody system: Plasma insulin levels of normal, subdiabetic and diabetic rats . Diabetes 12:115-126, 1963;.
7 +
Glick SM, Roth J, Yalow RS, et al:  Immunoassay of human growth hormone in plasma . Nature 199:784-787, 1963;.
8 +
Goodman HG, Grumbach MM, Kaplan SL:  Growth and growth hormone: II. A comparison of isolated growth-hormone deficiency and multiple pituitary-hormone deficiencies in 35 patients with idiopathic hypopituitary dwarfism . New Eng J Med 278:57-68, 1968;.
9 +
Werner SC: The Thyroid , ed 2. New York, Harper & Row Publishers Inc, 1962;, p 809.
10 +
Nadler H, Neumann LL, Gershberg H:  Hypoglycemia, growth retardation and probable isolated growth hormone deficiency in a 1-year-old child . J Pediat 63:977-983, 1963;.
11 +
Wilber JF, Odell WD:  Hypoglycemia and dwarfism associated with the isolated deficiency of growth hormone . Metabolism 14:590-597, 1965;.
12 +
Brasel JA, Wright JC, Wilkins L, et al:  An evaluation of 75 patients with hypopituitarism beginning in childhood . Amer J Med 38:484-498, 1965;.
13 +
Beck JC, McGarry EE, Dyrenfurth I, et al:  Primate growth hormone studies in man . Metabolism 9:699-737, 1960;.
14 +
Stamp TCB:  Plasma non-esterified fatty acid levels in hypopituitary subjects . J Endocr 35:107-115, 1966;.
15 +
Raben MS, Hollenberg CH:  Effect of growth hormone on plasma fatty acids . J Clin Invest 38:484-488, 1959;.
16 +
Ikkos D, Luft R, Gemzell CA:  The effect of human growth hormone in man . Lancet 1:720-721, 1958;.
17 +
Luft R, Ikkos D, Gemzell CA, et al:  Effect of human growth hormone in hypophysectomized diabetic subjects . Lancet 1:721-722, 1958;.
18 +
Senior B, Loridan L:  Gluconeogenesis and insulin in the ketotic variety of childhood hypoglycemia and in control children . J Pediat 74:529-539, 1969;.
19 +
Steiner MM, Boggs JD:  Absence of pituitary gland, hypothyroidism, hypoadrenalism and hypogonadism in a 17-year-old dwarf . J Clin Endocr 25:1591-1598, 1965;.
20 +
Madison LL, Combes B, Adams R, et al:  The physiological significance of the secretion of endogenous insulin into the portal circulation: III. Evidence for a direct immediate effect of insulin on the balance of glucose across the liver . J Clin Invest 39:507-522, 1960;.
21 +
Drash A, Wolff F, Langs H, et al:  Diazoxide induced diabetes mellitus in a hypopituitary dwarf . Diabetes 15:319-322, 1966;.
22 +
Fajans SS, Floyd JC Jr, Knopf RF, et al:  Benzothiadiazine suppression of insulin release from normal and abnormal islet tissue in man . J Clin Invest 45:481-492, 1966;.
23 +
Luft R, Cerasi E:  Effect of human growth hormone on insulin production in panhypopituitarism . Lancet 2:124-126, 1964;.
24 +
Gold H, Spector S, Samaan NA, et al:  Effect of growth hormone on the carbohydrate metabolism in hypopituitary dwarfs . Metabolism 17:74-83, 1968;.

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