July - September 2006, Volume 2, Issue 3

Stanescu A, Ritivoiu M, Anca I

Management of persistent hyperinsulinemic hypoglycemia of infancy (PHHI) - a challenge for the pediatrician

Acta Endo (Buc) 2006, 2 (3): 349-354
doi: 10.4183/aeb.2006.349

We present a 6 months male infant with persistent hyperinsulinemic hypoglycemia of infancy (PHHI)- the former nesidioblastosis. The main presenting symptoms were recurrent episodes of hypoglycemic seizures (persistent hypoglycemic status of 30 mg/dL serum glucose) high requirements of i.v. glucose for maintaining euglycemic status. The main diagnostic markers were: high insulin to glucose ratio,negative urinary ketones, normal growth hormone level, normal cortisol level during hypoglycemia, no visible pathological masses on abdominal and cranial MRI . As a medical treatment we used Octreotid and we needed several adjustments of the dose to maintain euglycemic status, between 4 ?g/kg/day s.c. and 10 ?g/kg/day s.c. Our goal were to prevent the neurological damage and the minimum compromise in the fragile equilibrium of advantages and disadvantages of the treatment in order to maintain the best outcome we could get. Our patient is in his second year of treatment with no severe hypoglycemia during the last 12 months and with good neurological and physical development. The long term outcome is difficult to be predicted.

Keywords: hyperinsulinemia, hypoglycemia, seizures, infant, octreotide

Correspondence: Alina Stanescu, Str. Alexandru Donici nr. 2, sector 2, Bucharest, Romania, e-mail : stanescualina@yahoo.com