Background: Cortisol and growth hormone elevations are critical counterregulatory responses to severe hypoglycemia. However, the proportion and clinical characteristics of type 2 diabetic patients who fail to show appropriate cortisol and/or growth hormone secretion in response to severe hypoglycemia have not been investigated.
Methods: We measured the plasma cortisol and growth hormone levels in type 2 diabetes with severe hypoglycemia (defined as blood glucose < 40 mg/dl with loss of consciousness) who visited the emergency department between 2006 and 2015.
Results: Of 187 hypoglycemic patients, 37 (19.8%) had impaired cortisol responses (<18 μg/dl) and 143 (76.5%) patients had impaired growth hormone responses (<5 ng/ml). There were 31 (16.6%) patients with impaired responses to both cortisol and growth hormone. The patients with impaired cortisol response, growth hormone response and both hormone response were significantly older (74.0, 76.0, 74.0 vs. 69.5 years) and had higher BMI (24.8, 23.7, 23.8 vs. 21.6 kg/m2) compared with normal hormone response group. Individuals with impaired cortisol response group, impaired growth hormone response group and both hormone abnormal response group showed significantly higher admission rates (35.1%, 35.9%, 32.3% vs. 2.6%), lower growth hormone level (0.8, 0.8, 0.6 vs. 12.7 ng/ml), and lower adrenocorticotropic hormone (ACTH) level (20.0, 34.4, 19.5 vs 105.5 pg/ml) than individuals with normal hormone response group. Multivariate logistic regression analysis indicated that impaired cortisol response were significantly associated with growth hormone after adjusting for age, BMI, DM duration, and ACTH. Impaired growth hormone response were significantly associated with age, BMI, and ACTH after adjusting for eGFR.
Conclusion: A considerable number of type 2 diabetic patients have impaired cortisol and/or growth hormone responses to severe hypoglycemia. The type 2 diabetic patients likely to have abnormal GH response when they are older, have shorter DM duration, and have higher BMI.
Keywords: hypoglycemia, cortisol, growth hormone, type 2 diabetes mellitus, counterregulatory hormone response
19 May 2018 - 22 May 2018