Hyperinsulinism in children: Diagnostic value of pancreatic venous sampling correlated with clinical, pathological and surgical outcome in 25 cases
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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.
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- 3.Reichardt W (1980) Selective phlebography in pancreatic and peripancreatic disease. Acta Radiol Diagn 21: 513–522Google Scholar
- 9.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 151–202Google Scholar
- 11.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: 780Google Scholar
- 12.Fulton RE, Sheedy PF II, McIrath DC, Ferris DO (1985) Preoperative angiographic localization of insulin-producing tumors of the pancreas. AJR 123: 367–377Google Scholar