Related Experiment Videos
Hypoglycemia of infancy and nesidioblastosis. Studies with somatostatin
Insights
This study treated infant hypoglycemia and nesidioblastosis using glucose infusions and somatostatin. Somatostatin effectively controlled elevated insulin levels, demonstrating its potential for treating hyperinsulin states in infants.
Area of Science:
- Pediatric Endocrinology
- Metabolic Disorders
Background:
- Infantile hypoglycemia, particularly with nesidioblastosis, presents a significant clinical challenge.
- Managing persistent hyperinsulinism requires understanding abnormal glucose and insulin regulation.
Observation:
- A two-month-old infant with severe intractable hypoglycemia and nesidioblastosis was treated with continuous glucose infusions.
- Basal serum insulin levels were inappropriately elevated relative to blood glucose levels.
- Beta cells showed high sensitivity to synthetic cyclic somatostatin infusions, with dose-dependent effects on glucose and insulin.
Findings:
- Continuous glucose infusions maintained preprandial glucose levels at 37+/-2 mg/dL.
- Synthetic cyclic somatostatin effectively suppressed elevated insulin levels while minimally affecting glucagon.
- Protamine zinc somatostatin injections provided sustained glycemic control for 4-5 days.
Implications:
- Infantile hypoglycemia in this case was characterized by a hyperinsulin state with dysregulated basal insulin secretion.
- Somatostatin demonstrates therapeutic potential for managing hyperinsulinemic hypoglycemia in infants.
- These findings highlight the critical role of insulin regulation in neonatal glucose homeostasis.
Abstract:
We treated a two-month-old infant with servere intractable hypoglycemia and nesidioblastosis with continuous glucose infusions (0.75 g per kilogram per hour) via a central venous catheter. Preprandial glucose levels on this regimen were 37+/-2 mg per deciliter (+/-S.E.M.). Basal serum insulin levels were within normal fasting levels for this age group but inappropriately elevated for the blood glucose levels. The beta cells were exquisitely sensitive to infusions of synthetic cyclic somatostatin, with a dose-dependent rise in blood glucose and concomitant suppression of serum insulin levels. There was only minimal suppression of plasma glucagon levels. Single subcutaneous injections of 50 microng of protamine zinc somatostatin raised preprandial blood glucose levels to 83+/-3 mg per deciliter for four to five days although preprandial hormone levels were unchanged. These findings indicate that hypoglycemia of infancy is a hyperinsulin state with abnormal basal regulation of insulin secretion.