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Endocrine disorders of the pancreas and adrenal cortex in pediatric patients
Insights
Early diagnosis and treatment of hyperinsulinemic hypoglycemia in children are crucial to prevent central nervous system damage. Subtotal pancreatectomy is an effective treatment when medical therapy fails, reducing hypoglycemia severity.
Area of Science:
- Pediatric Endocrinology
- Surgical Management of Endocrine Disorders
Background:
- Hyperinsulinemic hypoglycemia is a significant cause of persistent hypoglycemia in infants and children.
- Untreated hyperinsulinemic hypoglycemia can lead to irreversible central nervous system damage.
- Typical symptoms include tremors, seizures, and apnea, often unresponsive to initial medical treatments.
Purpose of the Study:
- To highlight the importance of early diagnosis and treatment of hyperinsulinemic hypoglycemia in pediatric patients.
- To discuss the efficacy of subtotal pancreatectomy in managing severe hyperinsulinemic hypoglycemia.
- To review surgical outcomes for pediatric adrenal tumors.
Main Methods:
- Review of clinical manifestations and treatment outcomes for hyperinsulinemic hypoglycemia.
- Evaluation of subtotal pancreatectomy as a therapeutic option.
- Analysis of survival rates for pediatric adrenocortical adenomas and carcinomas.
Main Results:
- Subtotal pancreatectomy effectively reduces the severity of hyperinsulinemic hypoglycemia, though it may not completely correct it.
- Surgical treatment for pediatric Cushing's syndrome and aldosteronoma has shown positive results.
- Survival rates for adrenocortical adenomas were 100%, while four of nine children with adrenocortical carcinomas younger than 10 years survived.
Conclusions:
- Prompt diagnosis and intervention are vital for managing hyperinsulinemic hypoglycemia in children.
- Subtotal pancreatectomy is a valuable surgical option for refractory cases.
- Surgical outcomes for pediatric adrenal tumors vary, with carcinomas presenting a poorer prognosis, especially in older children.
Abstract:
Hyperinsulinemia, a common cause of persistent hypoglycemia in infants and children, can result in permanent damage to the central nervous system. Thus, early diagnosis and treatment are important. The typical clinical manifestation of hyperinsulinemic hypoglycemia is symptomatic hypoglycemia that responds poorly to medical therapy. Affected infants may have tremors, jitteriness, apnea, cyanosis, or seizures. If initial medical therapy (frequent feedings, large amounts of intravenously administered glucose, diazoxide, and glucocorticoids) fails to stabilize plasma glucose levels, subtotal pancreatectomy is indicated. This surgical intervention does not completely correct the hypoglycemia in all patients, but it effectively reduces the severity of the condition. Surgical treatment of pediatric patients with Cushing's syndrome or aldosteronoma has also been effective. In our experience, survival of patients with adrenocortical adenomas has been 100%, whereas only five of nine children with adrenocortical carcinomas survived, and four of the five were younger than 10 years of age.