Table 1

 Baseline biochemistry and peak cortisol levels following insulin induced hypoglycaemia in two female adult patients taking inhaled/intranasal corticosteroids

Patient 1Patient 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)169/198113/198
08.00 ACTH (<12 pmol/l)4.52.8/2.9
Insulin-like growth factor-1 (0.4–1.6 U/ml)0.540.89/0.79
Free thyroxine (10–21 pmol/l)1115.9/15.6*
Thyroid stimulating hormone (0.3–4 mIU/l)0.771.77/1.95*
Prolactin (50–370 mIU/l)224111/87
Luteinising hormone (IU/l)†11.326.4/18.4
Follicular stimulating hormone (IU/l)‡6.550.1/42.7
α-subunit (IU/l)§0.41Not done
Anti-microsomal antibodiesNegativePositive
Dehydrepiandrosterone (µmol/l)¶<1.0<1.0
Results of insulin tolerance test
Baseline cortisol (200–600 nmol/l)160159
Minimum blood glucose (<2.2 mmol/l)1.91.6
30 minute cortisol (nmol/l)327343
60 minute cortisol (nmol/l)450492
90 minute cortisol (nmol/l)313388
120 minute cortisol (nmol/l)227282
Peak growth hormone (>13 mU/l)40.34.9