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Surgical management of hyperinsulinemic hypoglycemia in children
Insights
Subtotal pancreatectomy effectively treated hyperinsulinemic hypoglycemia in 19 children. This surgery improved outcomes for infants and older children, with most patients experiencing symptom relief and no complications.
Area of Science:
- Pediatric Surgery
- Endocrinology
- Gastroenterology
Background:
- Hyperinsulinemic hypoglycemia is a rare but serious condition in children.
- Management often requires surgical intervention when medical therapies fail.
Purpose of the Study:
- To evaluate the safety and efficacy of subtotal pancreatectomy in pediatric patients with hyperinsulinemic hypoglycemia.
Main Methods:
- Nineteen children with hyperinsulinemic hypoglycemia underwent subtotal pancreatectomy.
- Patients were stratified by age at symptom onset (infants vs. older children).
- Histopathological findings (islet adenomas, endocrine cell dysplasia) were analyzed.
Main Results:
- All 19 patients showed clinical improvement post-surgery.
- Four children required a second procedure (near-total pancreatectomy) for persistent hypoglycemia.
- No postsurgical complications were reported.
- Two patients developed secondary diabetes mellitus requiring insulin therapy.
Conclusions:
- Subtotal pancreatectomy is a safe and effective surgical option for pediatric hyperinsulinemic hypoglycemia.
- The procedure leads to significant symptom improvement and resolution of hypoglycemia.
- Careful patient selection and follow-up are important for managing potential complications like fat malabsorption and secondary diabetes.
Abstract:
Nineteen children underwent subtotal pancreatectomy for hyperinsulinemic hypoglycemia. Of the four who were older than 10 years of age at onset of symptoms, three had islet adenomas, and one had endocrine cell dysplasia (ECD). The two patients with multiple adenomas had a family history of multiple endocrine neoplasia, type 1 (MEN 1). Of the 15 who were younger than 1 year of age at onset of symptoms, 12 had ECD alone, and three had ECD with adenomatosis. Four children required a second surgical procedure and near-total pancreatectomy because of persistent hypoglycemia. All 19 patients' conditions improved, with no postsurgical complications. After near-total pancreatectomy, all four patients were treated for fat malabsorption, but only two required insulin because of secondary diabetes mellitus. We concluded that subtotal pancreatectomy is a safe, effective adjunct to the treatment of children with hyperinsulinemic hypoglycemia.