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Robotic Enucleation of an Intra-Pancreatic Insulinoma in the Pancreatic Head
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Robotic Enucleation of an Intra-Pancreatic Insulinoma in the Pancreatic Head

Published on: January 3, 2020

The surgical treatment of hyperinsulinism in infancy and childhood

M H Gough

    The British Journal of Surgery
    |January 1, 1984
    PubMed

    Insights

    Infantile hyperinsulinaemic hypoglycaemia can be transient or persistent. For persistent cases, particularly nesidioblastosis or insulinoma, increased pancreatic resection (up to 90%) is suggested for infants.

    Area of Science:

    • Pediatric Endocrinology
    • Surgical Gastroenterology
    • Neonatal Medicine

    Background:

    • Hyperinsulinaemic hypoglycaemia in infancy presents as transient or persistent forms.
    • Persistent cases stem from nesidioblastosis (diffuse pancreatic endocrine abnormality) or islet cell adenoma.
    • Untreated persistent hypoglycaemia can lead to severe neurological damage or death.

    Observation:

    • Medical therapy is effective for transient hypoglycaemia and some persistent cases.
    • Islet cell adenomas and many nesidioblastosis cases necessitate surgical intervention (partial or total pancreatectomy).
    • This study reviews the surgical management of seven patients (six infants, one child).

    Findings:

    • Five infants were diagnosed with nesidioblastosis.
    • One infant and one nine-year-old girl had an islet cell adenoma.
    • Surgical outcomes for these conditions were evaluated.

    Implications:

    • For infants with suspected hyperinsulinaemic hypoglycaemia and no evidence of insulinoma, a more extensive initial pancreatectomy (up to 90%) is proposed.
    • This contrasts with the previously recommended 75% resection.
    • Optimizing surgical strategy may improve outcomes for persistent infantile hypoglycaemia.

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