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Management challenges in a child with hyperinsulinemic hypoglycemia

Deepti Chaturvedi1, Rajesh Khadgawat1, Jeyaraman Kanakamani1

  • 1Department of Endocrinology, All India Institute of Medical Sciences, New Delhi, India.

Clinical Pediatric Endocrinology : Case Reports and Clinical Investigations : Official Journal of the Japanese Society for Pediatric Endocrinology
|May 3, 2014
PubMed

Insights

Malignant insulinoma, a rare pediatric cancer, was diagnosed in an 18-month-old child with islet cell hyperplasia. Despite surgical interventions, the child developed metastatic disease, representing the youngest reported case.

Area of Science:

  • Pediatric Oncology
  • Endocrinology
  • Surgical Gastroenterology

Background:

  • Malignant insulinoma is an exceptionally rare tumor in pediatric populations.
  • Hyperinsulinemic hypoglycemia in infants can be caused by various conditions, including rare pancreatic tumors.

Purpose of the Study:

  • To report the youngest known case of malignant insulinoma with metastatic disease in a child.
  • To highlight the diagnostic and management challenges of pediatric malignant insulinoma.

Main Methods:

  • Case presentation of an 18-month-old child with recurrent hyperinsulinemic hypoglycemia.
  • Diagnostic imaging including Magnetic Resonance Imaging (MRI) and Positron Emission Tomography (PET) scan.
  • Surgical management (enucleation and subtotal pancreatectomy) and histopathological confirmation with immunostaining.

Main Results:

  • The patient presented with hyperinsulinemic hypoglycemia, initially treated with tumor enucleation and later subtotal pancreatectomy.
  • Despite surgical interventions, metastatic insulinoma to the liver was confirmed.
  • This case represents the youngest reported instance of metastatic malignant insulinoma in a child.

Conclusions:

  • Malignant insulinoma, though rare, should be considered in pediatric cases of persistent hyperinsulinemic hypoglycemia.
  • Early and accurate diagnosis, coupled with aggressive management, is crucial for pediatric patients with malignant insulinoma.
  • Metastatic potential underscores the need for vigilant monitoring and advanced imaging in affected children.

Keywords:
childhoodliver metastasismalignant insulinoma

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