Abstract
Neonatal hypoglycemia represents an emergency of heterogenous etiology. The occurrence of persistent hypoglycemia caused by hyperinsulinism has not been well established. Some authors claim that it may be more common than previously suggested. The diagnostic goal is to distinguish hyperinsulinemia from other causes of hypoglycemia because management strategies differ. The diagnosis of persistent hypoglycemia attributable to hyperinsulinism is made when insulin secretion is excessive or inappropriate (>10 μIU/ml). Medical management includes frequent feeding, high hydrocarbon intake, glucagon, diazoxide, somatostatin or steroid treatment. In case of resistance to medical intervention, surgery consisting of subtotal pancreatectomy is performed to avoid neurological sequelae. However, pediatric organic hypoglycemia secondary to hyperinsulinism can be caused by either diffuse or focal pancreatic lesions. Differentiation between these two types of lesion is necessary since partail pancreatectomy can prevent diabetes. In this prospective study, pancreatic venous sampling (PVS) was evaluated for the preoperative localization of lesions in 25 children with hyperinsulinism and correlated with surgical, pathological and clinical outcome. PVS is the most accurate preoperative technique for localizing focal lesions in children. Besides being safe and effective, it has the great advantage of detecting focal secretion, thus reducing the need for extensive surgery.
Article PDF
Similar content being viewed by others
Avoid common mistakes on your manuscript.
References
Moreno LA, Turck D, Gottrand F, Fabre M, Manouvrier-Hanu S, Farriaux JP (1989) Familial hyperinsulinism with nesidioblastosis of the pancreas: Further evidence for autosomal recessive inheritance. Am J Med Genet 34: 584–586
Ingemansson S, Lunderquist A, Lunderquist I, et al (1975) Portal and pancreatic vein catheterization with radioimmunologic determination of insulin. Surg Gynecol Obstet 141: 705–711
Reichardt W (1980) Selective phlebography in pancreatic and peripancreatic disease. Acta Radiol Diagn 21: 513–522
Roche A, Raisonnier A, Gillon-Savouret MC (1982) Pancreatic venous sampling and arteriography in localizing insulinomas and gastrinomas: procedure and results in 55 cases. Radiology 145: 621–627
Rahier J, Falt K, Muntefering H, Becker K, Gepts W, Falkmer S (1984) The basic structural lesion of persistent neonatal hypoglycemia with hyperinsulinism: deficiency of D cells or hyperactivity of B cells? Diabetologia 26: 282–289
Rahier J, Wallon J, Henquin JC (1981) Cell populations in the endocrine pancreas of human neonates and infants. Diabetologia 20: 540–546
La Franchi S (1987) Hypoglycemia in infancy and childhood. Pediatr Clin North Am 34: 961–982
Amendt P, Kohnert KD, Kunz J (1988) The hyperinsulinaemic hypoglycemia in infancy: a study of six cases. Eur J Pediatr 148: 107–112
Soltesz G, Aynsley-Green A (1982) Hyperinsulinism in infancy and childhood. In: Frick P, Harnack GA, Kochsiek K, Martini GA, Prader A (eds) Advances in internal medicine and pediatrics. Springer, Berlin Heidelberg New York, pp 151–202
Koh THH, Eyre JA, Aynsley-Green A (1988) Neonatal hypoglycemia—the controversy regarding definition. Arch Dis Child 63: 1386–1398
Kirland J, Ben Menachem Y, Aktar M, Marshall R, Dudrick S (1978) Islet cell tumor in a neonate diagnosis by selective angiography and histological findings. Pediatrics 61: 780
Fulton RE, Sheedy PF II, McIrath DC, Ferris DO (1985) Preoperative angiographic localization of insulin-producing tumors of the pancreas. AJR 123: 367–377
Doppman JL, Miller DL, Chang R, Shawker TH, Gorden P, Norton JA (1991) Insulinomas: localization with selective intraarterial injection of calcium. Radiology 178: 237–241
Galiper AK, Reading CC, Charbonneau JW, Sheedy PF et al (1988) Localization of pancreatic insulinomas: comparison of pre- and intraoperative US with CT and angiography. Radiology 166: 405–408
Dunnick NR, Long JA Jr, Krudy A, Shawker TH, Doppman JL (1980) Localizing insulinomas with combined radiographic methods. AJR 135: 747–752
Rossi P, Baert A, Passariello R, Simonetti G, Pavone P, Tempesta P (1985) CT of functioning tumors of the pancreas. AJR 144: 57–60
Telander R, Charbonneau JW, Haymond MW (1986) Intraoperative ultrasonography of the pancreas in children. J Pediatr Surg 21: 262
Carcassonne M, DeLarue A, LeTourneau JN (1983) Surgical treatment of organic pancreatic hypoglycemia in the pediatric age. J Pediatr Surg 18: 75–79
Schiller M, Krausz M, Meyer S, Lijovetzky G, Landau H (1980) Neonatal hyperinsulinism—surgical and pathologic considerations. J Pediatr Surg 15: 16–20
Brunelle F, Negree V, Barth MO, Fekete CN, Czernichow P, Saudubray JM, Kuntz F, Tach T, Lallemand D (1989) Pancreatic venous sampling in infants and children with primary hyperinsulinism. Pediatr Radiol 19: 100–103
Demarquez, JL, Vital C, Babin JP, Allain O, Bondomy JM, Sauterel M, Tamon F, Martin C (1977) Adenome Langheransien à révèlation néonatale. Arch Fr Pediatr 34: 179
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Dubois, J., Brunelle, F., Touati, G. et al. Hyperinsulinism in children: Diagnostic value of pancreatic venous sampling correlated with clinical, pathological and surgical outcome in 25 cases. Pediatr Radiol 25, 512–516 (1995). https://doi.org/10.1007/BF02015782
Received:
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF02015782