Abstract 63: A case of adult-onset growth hormone deficiency associated with symptomatic post-prandial hypoglycemia

We present a case of 55 year old man, who had consulted us for recurrent hypoglycemia. Patient had no previous history of head trauma, tumor or radiation. Since last month he noticed post prandial excessive sweating, uneasiness and palpitations. On evaluation his plasma glucose 43 mg/dl. On examination, the patient was in good general health, with normal renal and hepatic function. During hospitalization, no hypoglycemic episodes were recorded during a 48-h fasting test. Biochemical data and abdominal computed tomography (CT) excluded insulinoma and tumor-induced hypoglycemia. The extended oral glucose tolerance test (OGTT) showed an impaired glucose tolerance with a tendency towards symptomatic hypoglycemia (plasma glucose at fasting-98 mg/dl, 2nd hours-151 mg/dl, 3rd hour- 61 mg/dl). Hormonal analysis showed low levels of GH (0.073 ng/ml) in the critical sample and low IGF-I (51 ng/ml); the response of GH to glucagon confirmed a severe GHD (GH peak 0.16 ng/ml). Other pituitary and counter-regulation hormones were within the normal range and magnetic resonance imaging (MRI) of the pituitary gland showed partial empty sella. Patient was started on replacement with a dose of 0.2 mg of recombinant human growth hormone (rhGH), which led to increase in IGF-I up to normal values with complete regression of hypoglycemic events. In conclusion, we report a case of adult-onset growth hormone deficiency and it's association with post prandial hypoglycemia.