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Hyperinsulinism in infancy.

L C Low1, E C Yu, O K Chow

  • 1Department of Paediatrics, Queen Mary Hospital, Hong Kong.

Australian Paediatric Journal
|June 1, 1989
PubMed
Summary
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Persistent hyperinsulinism in infants causes hypoglycemia. Diazoxide treatment showed side effects, while surgery was sometimes necessary. Phenytoin proved effective for post-surgical hypoglycemia.

Area of Science:

  • Pediatric Endocrinology
  • Neonatal Metabolism

Background:

  • Persistent hyperinsulinism is a significant cause of hypoglycemia in infants.
  • Diagnosis and management of this condition present considerable challenges.

Purpose of the Study:

  • To report on the clinical course and treatment outcomes of five infants with persistent hyperinsulinism.
  • To evaluate the efficacy and side effects of diazoxide and surgical interventions.

Main Methods:

  • Case series reporting on five infants with persistent hypoglycemia.
  • Assessment of provocative insulin release tests, diazoxide therapy, and subtotal pancreatectomy.
  • Evaluation of phenytoin for refractory hypoglycemia.

Main Results:

  • Diazoxide was partially effective but associated with significant side effects (rash, renal failure, cardiac failure).

Related Experiment Videos

  • Two patients achieved spontaneous remission.
  • Subtotal pancreatectomy was performed in two patients with nesidioblastosis; one experienced recurrence due to hyperinsulinism, the other due to glucagon deficiency. Phenytoin was effective in the recurrent hyperinsulinism case.

    • Conclusions:

    • Medical management with diazoxide and diuretics is recommended upon diagnosis of hyperinsulinism.
    • Early subtotal pancreatectomy should be considered if medical therapy fails or causes severe side effects.
    • Phenytoin may be a valuable option for managing post-pancreatectomy hypoglycemia.