PEDIATRICS Vol. 41 No. 5 May 1968, pp. 905-916
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HYPOPITUITARISM AND DIABETES MELLITUS: EFFECT OF HUMAN GROWTH HORMONE

Maurice D. Kogut M.D.1, George N. Donnell M.D.1, Shun M. Ling M.D.1, and S. Douglas Frasier M.D.1

1 Divisions of Metabolism and Endocrinology, Childrens Hospital of Los Angeles and the Department of Pediatrics, University of Southern California School of Medicine and the Department of Pediatrics, School of Medicine, U.C.L.A. Center for the Health Sciences, Los Angeles

Although hypoglycemia and insulin sensitivity are characteristic of hypopituitarism, the association of hypoglycemia, diabetes mellitus, and pituitary insufficiency has not been previously described in a child. Studies in a 44-month-old male with these features and observations following human growth hormone administration are reported.

The patient weighed 7 lb, 9 oz at birth and was 20 in. long, but he did not grow or gain weight as expected. There was a strong family history of diabetes mellitus. At age 17 months hypoglycemic seizures occured (blood glucose < 5 mg/100 ml). An oral glucose tolerance test was abnormal. Subsequently, hyperglycemia and glycosuria, but not ketonuria, occured. Serum immunoreactive insulin following intravenous tolbutamide rose, suggesting endogenous insulin production. The treatment of diabetes mellitus with insulin was extremely difficult because of marked sensitivity, suggesting an additional cause for altered glucose homeostasis. Endocrine studies (PBI, I131 uptake before and after TSH, 24-hour urines for 17-ketosteroids and 17-ketogenic steroids following metopirone and ACTH, and immunoassays of serum growth hormone following intravenous administration of insulin and L-arginine) indicated lack of normal activity of thyrotropin, ACTH, and growth hormone. Human growth hormone, 1.0 mg. daily, resulted in a growth of 5frac12 in. and a weight gain of 11 lb in 8 months. There were no further episodes of hypoglycemia which facilitated control of the diabetes with insulin. These observations have demonstrated the importance of HGH in glucose homeostasis and that HGH is not necessary for the development of diabetes mellitus.

Submitted on July 25, 1967
Accepted on November 22, 1967