Baseline biochemistry and peak cortisol levels following insulin induced hypoglycaemia in two female adult patients taking inhaled/intranasal corticosteroids
| Patient 1 | Patient 2 | |
|---|---|---|
| Normal ranges and units are in brackets. “Normal” peak cortisol level following hypoglycaemia >550 nmol/l. When more than one value is quoted, the tests were performed on different days. | ||
| *On thyroxine. | ||
| †Reference range (RR): females – premenopausal 2.5–130 IU/l, postmenopausal >15 IU/l, males 1.5–14 IU/l. | ||
| ‡RR: females – premenopausal 1.6–33 IU/l, postmenopausal >16 IU/l, males 0.9–8.1 IU/l. | ||
| §RR: males and females – premenopausal 0.05–0.4 IU/l, postmenopausal 0.37–1.15 IU/l. | ||
| ¶RR: females – premenopausal 2.2–9.1 µmol/l, postmenopausal 0.3–1.7 µmol/l, males 5.3–9 µmol/l. | ||
| 08.00 cortisol (200–600 nmol/l) | 169/198 | 113/198 |
| 08.00 ACTH (<12 pmol/l) | 4.5 | 2.8/2.9 |
| Insulin-like growth factor-1 (0.4–1.6 U/ml) | 0.54 | 0.89/0.79 |
| Free thyroxine (10–21 pmol/l) | 11 | 15.9/15.6* |
| Thyroid stimulating hormone (0.3–4 mIU/l) | 0.77 | 1.77/1.95* |
| Prolactin (50–370 mIU/l) | 224 | 111/87 |
| Luteinising hormone (IU/l)† | 11.3 | 26.4/18.4 |
| Follicular stimulating hormone (IU/l)‡ | 6.5 | 50.1/42.7 |
| α-subunit (IU/l)§ | 0.41 | Not done |
| Anti-microsomal antibodies | Negative | Positive |
| Dehydrepiandrosterone (µmol/l)¶ | <1.0 | <1.0 |
| Results of insulin tolerance test | ||
| Baseline cortisol (200–600 nmol/l) | 160 | 159 |
| Minimum blood glucose (<2.2 mmol/l) | 1.9 | 1.6 |
| 30 minute cortisol (nmol/l) | 327 | 343 |
| 60 minute cortisol (nmol/l) | 450 | 492 |
| 90 minute cortisol (nmol/l) | 313 | 388 |
| 120 minute cortisol (nmol/l) | 227 | 282 |
| Peak growth hormone (>13 mU/l) | 40.3 | 4.9 |