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Long-Term Outcome and Treatment in Persistent and Transient Congenital Hyperinsulinism: A Finnish Population-Based
Jonna M E Männistö1, Jarmo Jääskeläinen1, Timo Otonkoski2
1Department of Pediatrics, University of Eastern Finland and Kuopio University Hospital, Kuopio, Finland.
Context:
The management of congenital hyperinsulinism (CHI) has improved.
Objective:
To examine the treatment and long-term outcome of Finnish patients with persistent and transient CHI (P-CHI and T-CHI).
Design:
A population-based retrospective study of CHI patients treated from 1972 to 2015.
Patients:
106 patients with P-CHI and 132 patients with T-CHI (in total, 42 diagnosed before and 196 after year 2000) with median follow-up durations of 12.5 and 6.2 years, respectively.
Main Outcome Measures:
Recovery, diabetes, pancreatic exocrine dysfunction, neurodevelopment.
Results:
The overall incidence of CHI (n = 238) was 1:11 300 live births (1972-2015). From 2000 to 2015, the incidence of P-CHI (n = 69) was 1:13 500 and of T-CHI (n = 127) 1:7400 live births. In the 21st century P-CHI group, hyperinsulinemic medication was initiated and normoglycemia achieved faster relative to earlier. Of the 74 medically treated P-CHI patients, 68% had discontinued medication. Thirteen (12%) P-CHI patients had partial pancreatic resection and 19 (18%) underwent near-total pancreatectomy. Of these, 0% and 84% developed diabetes and 23% and 58% had clinical pancreatic exocrine dysfunction, respectively. Mild neurological difficulties (21% vs 16%, respectively) and intellectual disability (9% vs 5%, respectively) were as common in the P-CHI and T-CHI groups. However, the 21st century P-CHI patients had significantly more frequent normal neurodevelopment and significantly more infrequent diabetes and pancreatic exocrine dysfunction compared with those diagnosed earlier.
Conclusions:
Our results demonstrated improved treatment and long-term outcome in the 21st century P-CHI patients relative to earlier.
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