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Tolerance to somatostatin analogue in a preterm infant with islet cell dysregulation syndrome
J M Hawdon1, M P Ward Platt, W H Lamb
1Department of Child Health, Princess Mary Hospital, Newcastle upon Tyne.
Insights
Neonatal hypoglycemia in preterm infants can be treated with somatostatin analogue, but rapid tolerance necessitates dose escalation or alternative therapies. This case highlights the need for careful monitoring during treatment.
Area of Science:
- Neonatology
- Pediatric Endocrinology
- Pharmacology
Background:
- Neonatal hypoglycemia is a common metabolic issue in preterm infants.
- Islet cell dysregulation can cause persistent hypoglycemia.
- Somatostatin analogue is a potential treatment for refractory hypoglycemia.
Observation:
- A 31-week preterm infant presented with severe, refractory hypoglycemia.
- Initial treatment with somatostatin analogue improved glycemic control.
- Significant tolerance to somatostatin analogue developed rapidly, requiring a 40-fold dose increase.
Findings:
- Somatostatin analogue is safe for use in preterm infants.
- Rapid tolerance development to somatostatin analogue is a significant clinical challenge.
- Pancreatectomy was ultimately required for glycemic management.
Implications:
- Early recognition of tolerance is crucial for effective glycemic management in neonates.
- Alternative or adjunctive therapies may be needed when tolerance develops.
- This case underscores the complex pharmacodynamics of somatostatin analogue in preterm neonates.
Abstract:
An infant of 31 weeks' gestation presented with refractory neonatal hypoglycaemia secondary to islet cell dysregulation. Treatment was started with somatostatin analogue and his glycaemic control improved initially. Tolerance developed, however, in that the dose required to maintain control increased by a factor of 40. The infant subsequently underwent pancreatectomy. It is safe to use somatostatin analogue in a preterm infant, but tolerance to the drug rapidly develops.