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[Preoperative management of newborn infants with hyperinsulinemic hypoglycemia (2)]
1Abteilung für Neonatologie, Universitäts-Klinik Wien.
Insights
Cyclic somatostatin (S) partially suppressed hormones in infants with persistent hyperinsulinism, preventing hypoglycemia during preoperative management. The somatostatin sensitivity test (SST) helps determine the optimal S dose for achieving normoglycemia.
Area of Science:
- Pediatric Endocrinology
- Metabolic Disorders
- Surgical Management
Background:
- Persistent hyperinsulinism in infants, caused by nesidioblastosis or pancreatic microadenoma, requires effective preoperative management.
- Cyclic somatostatin (S) administration is a potential therapeutic strategy prior to subtotal pancreatectomy.
Observation:
- Four infants (ages 12-89 days) with persistent hyperinsulinism received cyclic somatostatin as part of preoperative management.
- The "somatostatin sensitivity test" (SST) was employed to assess individual hormonal responses to stepwise increasing somatostatin doses.
Findings:
- Somatostatin infusion achieved normoglycemia with a dextrose infusion at 5 mg/kg/min.
- Partial suppression of insulin (61% decrease), C-peptide (64% decrease), and a 23% increase in glucagon were observed.
- Hormonal suppression was partial, avoiding recurrent hypoglycemia and complete suppression of key hormones like HGH and cortisol.
Implications:
- The SST is a clinically practical tool for determining individualized somatostatin dosages to achieve normoglycemia.
- This approach mitigates the risk of complete somatostatin-induced suppression of essential hormones, optimizing patient safety.
- Effective preoperative management with somatostatin can improve outcomes for infants undergoing subtotal pancreatectomy for hyperinsulinism.
Abstract:
Four infants (three boys and one girl, ages 12-89 days) with persistent hyperinsulinism secondary to nesidioblastosis (two) or microadenoma of the pancreas (two) were treated with cyclic somatostatin (S) as part of the preoperative management until subtotal pancreatectomy was performed within 12 to 35 days. The individual dose dependent response of glucoregulatory hormones to exogenous was evaluated by means of the "somatostatin sensitivity test" (SST). Thereby S was infused in stepwise increasing doses, as dictated by the prevailing blood glucose levels, until normoglycemia was achieved concomitantly with a dextrose infusion at rates of 5 mg/kg/min. This procedure resulted only in a partial suppression of insulin, C-peptide, glucagon, HGH and cortisol, without recurrence of hypoglycemia. Compared to baseline levels, plasma concentrations of insulin decreased by 61%, of C-peptide by 64% and a rise of glucagon by 23% was observed. The SST which can be performed under routine clinical conditions, is a useful procedure for evaluating the individual S-dose necessary to achieve normoglycemia. The risk of total S-induced suppression of hormones, such as IRI, IRCP, HGH, glucagon and cortisol can be omitted.