Pediatric Radiology

, Volume 25, Issue 7, pp 512–516 | Cite as

Hyperinsulinism in children: Diagnostic value of pancreatic venous sampling correlated with clinical, pathological and surgical outcome in 25 cases

  • J. Dubois
  • F. Brunelle
  • G. Touati
  • G. Sebag
  • C. Nuttin
  • T. Thach
  • C. Nikoul-Fekete
  • J. Rahier
  • J. M. Saudubray


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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  1. 1.
    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: 584–586CrossRefPubMedGoogle Scholar
  2. 2.
    Ingemansson S, Lunderquist A, Lunderquist I, et al (1975) Portal and pancreatic vein catheterization with radioimmunologic determination of insulin. Surg Gynecol Obstet 141: 705–711PubMedGoogle Scholar
  3. 3.
    Reichardt W (1980) Selective phlebography in pancreatic and peripancreatic disease. Acta Radiol Diagn 21: 513–522Google Scholar
  4. 4.
    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: 621–627PubMedGoogle Scholar
  5. 5.
    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: 282–289CrossRefPubMedGoogle Scholar
  6. 6.
    Rahier J, Wallon J, Henquin JC (1981) Cell populations in the endocrine pancreas of human neonates and infants. Diabetologia 20: 540–546CrossRefPubMedGoogle Scholar
  7. 7.
    La Franchi S (1987) Hypoglycemia in infancy and childhood. Pediatr Clin North Am 34: 961–982PubMedGoogle Scholar
  8. 8.
    Amendt P, Kohnert KD, Kunz J (1988) The hyperinsulinaemic hypoglycemia in infancy: a study of six cases. Eur J Pediatr 148: 107–112CrossRefPubMedGoogle Scholar
  9. 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
  10. 10.
    Koh THH, Eyre JA, Aynsley-Green A (1988) Neonatal hypoglycemia—the controversy regarding definition. Arch Dis Child 63: 1386–1398PubMedGoogle Scholar
  11. 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. 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
  13. 13.
    Doppman JL, Miller DL, Chang R, Shawker TH, Gorden P, Norton JA (1991) Insulinomas: localization with selective intraarterial injection of calcium. Radiology 178: 237–241PubMedGoogle Scholar
  14. 14.
    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: 405–408PubMedGoogle Scholar
  15. 15.
    Dunnick NR, Long JA Jr, Krudy A, Shawker TH, Doppman JL (1980) Localizing insulinomas with combined radiographic methods. AJR 135: 747–752PubMedGoogle Scholar
  16. 16.
    Rossi P, Baert A, Passariello R, Simonetti G, Pavone P, Tempesta P (1985) CT of functioning tumors of the pancreas. AJR 144: 57–60PubMedGoogle Scholar
  17. 17.
    Telander R, Charbonneau JW, Haymond MW (1986) Intraoperative ultrasonography of the pancreas in children. J Pediatr Surg 21: 262CrossRefPubMedGoogle Scholar
  18. 18.
    Carcassonne M, DeLarue A, LeTourneau JN (1983) Surgical treatment of organic pancreatic hypoglycemia in the pediatric age. J Pediatr Surg 18: 75–79PubMedGoogle Scholar
  19. 19.
    Schiller M, Krausz M, Meyer S, Lijovetzky G, Landau H (1980) Neonatal hyperinsulinism—surgical and pathologic considerations. J Pediatr Surg 15: 16–20PubMedGoogle Scholar
  20. 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: 100–103PubMedGoogle Scholar
  21. 21.
    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: 179PubMedGoogle Scholar

Copyright information

© Springer-Verlag 1995

Authors and Affiliations

  • J. Dubois
    • 1
  • F. Brunelle
    • 2
  • G. Touati
    • 3
  • G. Sebag
    • 2
  • C. Nuttin
    • 3
  • T. Thach
    • 4
  • C. Nikoul-Fekete
    • 5
  • J. Rahier
    • 6
  • J. M. Saudubray
    • 3
  1. 1.Department of RadiologyHôpital Sainte-JustineMontréalCanada
  2. 2.Department of RadiologyHôpital Enfants-MaladesParisFrance
  3. 3.Department of EndocrinologyHôpital Enfants-MaladesParisFrance
  4. 4.Department of AnesthesiologyHôpital Enfants-MaladesParisFrance
  5. 5.Department of SurgeryHôpital Enfants-MaladesParisFrance
  6. 6.Department of PathologyUniversity Hospital St-Luc of LouvainBrusselsBelgium

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