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Treatment of hyperinsulinemic hypoglycemia because of diffuse nesidioblastosis with nifedipine after surgical therapies in a newborn
- Source :
- Journal of pediatric endocrinologymetabolism : JPEM. 26(11-12)
- Publication Year :
- 2013
-
Abstract
- Recent studies have demonstrated a role for calcium channel blocking agents in the treatment of persistent hyperinsulinemic hypoglycemia of newborns. We report a newborn infant with persistent hyperinsulinemic hypoglycemia whom we successfully treated with oral nifedipine alone after surgical therapies. A 4-day-old male infant was referred with intractable hypoglycemia and seziures. Normoglycaemia could be maintained only by the intravenous infusion of glucose at a rate of 20 mg/kg per minute. Persistent hyperinsulinemic hypoglycemia of newborn was diagnosed from an inappropriately raised plasma insulin concentration (44 mU/L) at the time of hypoglycemia. Medical treatments led to only a mild reduction in the intravenous glucose requirement; an 85-90% pancreatectomy was performed and histological "diffuse nesidioblastosis" was confirmed. However, despite all the medical treatments after the first pancreatectomy, the hyperinsulinemic hypoglycemia persisted and a second 95% pancreatectomy was performed. After the second pancreatectomy, persistent hyperinsulinemic hypoglycemia was treated with somatostatin and diazoxide, but led to no reduction in the intravenous glucose requirement. We report the case of an infant who had persistent hypoglycemia after two subtotal pancreatic resections but subsequently became normoglycemic on treatment with nifedipine (2 mg/kg per day). The patient was discharged home on oral nifedipine. Calcium channel blocking agents cuold be used with efficacy and safety in recurrent persistent hyperinsulinemic hypoglycemia.
- Subjects :
- Male
Nifedipine
Endocrinology, Diabetes and Metabolism
medicine.medical_treatment
Nesidioblastosis
Hypoglycemia
medicine.disease_cause
Endocrinology
medicine
Diazoxide
Hyperinsulinemia
Humans
Hyperinsulinemic hypoglycemia
business.industry
Infant, Newborn
nutritional and metabolic diseases
medicine.disease
Combined Modality Therapy
Somatostatin
Anesthesia
Pediatrics, Perinatology and Child Health
Pancreatectomy
Congenital Hyperinsulinism
business
medicine.drug
Subjects
Details
- ISSN :
- 21910251
- Volume :
- 26
- Issue :
- 11-12
- Database :
- OpenAIRE
- Journal :
- Journal of pediatric endocrinologymetabolism : JPEM
- Accession number :
- edsair.doi.dedup.....6353d4a5e437886cc7dc4a9747abbb88