My seven year old had extremely high insulin and cortisone levels so her doctor referred her to an endocrinologist. What causes this?

“Cortisone” (probably more correct as “cortisol”) is an adrenal gland hormone that is essential for life. It is one of the “stress” hormones, and we make a lot of cortisol with situations of increased physical, and sometimes emotional, stress. It does not take a lot of stress — even a difficult blood draw procedure can increase cortisol production into the blood. There usually is a two-phased cortisol production pattern under everyday situations: we generally make “a lot” in the morning and then we make another “pulse” in the late afternoon to early evening. Deficient cortisol can be life threatening. Prolonged excess cortisol in childhood would be expected to lead to stunting of growth in height, increased weight gain, stretch marks, elevations in blood pressure, and redistribution of body fat often leading to facial and trunkal weight gain, but less so in the arms and legs. Worrisome causes of chronic excess cortisol in children, fortunately, are rare. Excess cortisol can also lead to higher blood sugars (to “mimic” diabetes) and higher blood sugar can lead to a compensatory increase in insulin.

Type 2 diabetes, which is associated with insulin resistance can have a similar picture. A dramatic form of this can also be associated with elevations in cholesterol, increased male hormone production in males and females (with the latter having irregular menstruation), high blood pressure and others. This is sometimes called the metabolic syndrome, and sometimes given the very poor name of “Syndrome X.”

Talk with your child’s doctor about what they are looking for, but in general, the best way to assess for excess cortisol is through a carefully timed 24 hour urine collection.

DS
Additional comments from Dr. Donough O’Brien:

I think this is a situation that could be quite complex, and at this stage, really needs to be interpreted by the endocrinologist who will have full access to all the clinical and laboratory data.

DOB
Additional comments from Dr. Tessa Lebinger:

You did not say why these blood tests were drawn or under what circumstances (i.e., time of day, before a meal, after a meal). As both cortisol and insulin levels vary during the day and under different circumstances, results have to be interpreted in light of what problem your child has and under what circumstances the tests were done.”High values” aren’t always abnormal under certain circumstances.

TGL