Can growth hormone deficiency cause hypoglycemia (low blood sugar levels)?

Growth Hormone Deficiency and Hypoglycemia

Yes, growth hormone deficiency can cause hypoglycemia, particularly in children, but it can also occur in adults with severe growth hormone deficiency. Growth hormone plays a critical role in maintaining normal blood glucose levels, especially during fasting states.

Pathophysiology of Hypoglycemia in Growth Hormone Deficiency

• Growth hormone is a key counter-regulatory hormone that helps maintain glucose homeostasis, particularly during fasting periods 1
• In growth hormone deficiency, especially in children, there is increased insulin sensitivity which can lead to fasting hypoglycemia 1
• Growth hormone normally stimulates gluconeogenesis (glucose production) in the liver and reduces peripheral glucose utilization, which helps maintain blood glucose levels during fasting 2
• Without adequate growth hormone, this protective mechanism against hypoglycemia is impaired 3

Clinical Presentation

• Symptomatic hypoglycemia is more commonly described in children with severe growth hormone deficiency but can also occur in adults 3
• In adults with growth hormone deficiency, hypoglycemia may present as:
  • Recurrent hypoglycemic episodes, especially during fasting or periods of stress 3
  • Hypoglycemia unawareness (lack of warning symptoms when blood glucose drops) 4
  • Low blood glucose levels (<70 mg/dL or 3.9 mmol/L) that may become severe (<54 mg/dL or 3.0 mmol/L) 5

Diagnostic Considerations

• Blood glucose monitoring is essential in patients with suspected growth hormone deficiency 4
• Hypoglycemia in growth hormone deficiency may be overlooked because:
  • Symptoms can be subtle or absent (hypoglycemia unawareness) 4
  • The condition may be masked by other pituitary hormone deficiencies 3
• Insulin tolerance testing (ITT) used to diagnose growth hormone deficiency carries a risk of severe hypoglycemia in these patients, requiring close monitoring 4

Management Approaches

• Growth hormone replacement therapy is the primary treatment for hypoglycemia caused by growth hormone deficiency 3
• Even low doses of recombinant human growth hormone (rhGH) can help normalize blood glucose levels and prevent hypoglycemic episodes 3
• Blood glucose monitoring should be implemented:
  • During initiation of growth hormone therapy 2
  • During periods of stress or illness 5
  • Before and after exercise in susceptible individuals 5

Special Considerations

• Paradoxically, while children with growth hormone deficiency tend to be insulin-sensitive and prone to hypoglycemia, adults with untreated growth hormone deficiency may develop insulin resistance 6
• Growth hormone replacement therapy in adults may initially worsen insulin resistance, requiring careful dose titration 2
• Evening administration of growth hormone may help mimic natural circadian rhythm and minimize adverse effects on glucose metabolism 1

Treatment of Acute Hypoglycemia

• For conscious patients with hypoglycemia (<70 mg/dL or 3.9 mmol/L), administer 15-20g of glucose 5
• Recheck blood glucose after 15 minutes and repeat treatment if hypoglycemia persists 5
• Once blood glucose normalizes, the patient should consume a meal or snack to prevent recurrence 5
• For severe hypoglycemia or unconscious patients, glucagon administration is indicated 5
• Patients with recurrent hypoglycemia due to growth hormone deficiency should be evaluated for growth hormone replacement therapy 3