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The treatment of hyperinsulinemic hypoglycaemia in adults: an update

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Abstract

Background

Treatment of hyperinsulinemic hypoglycaemia (HH) is challenging due to the rarity of this condition and the difficulty of differential diagnosis. The aim of this article is to give an overview of the recent literature on the management of adult HH.

Methods

A search for reviews, original articles, original case reports between 1995 and 2016 in PubMed using the following keywords: hyperinsulinemic hypoglycaemia, insulinoma, nesidioblastosis, gastric bypass, autoimmune hypoglycaemia, hyperinsulinism, treatment was performed.

Results

One hundred and forty articles were selected and analysed focusing on the most recent treatments of HH.

Conclusions

New approaches to treatment of HH are available including mini-invasive surgical techniques and alternative local–regional ablative therapy for benign insulinoma and everolimus for malignant insulinoma. A correct differential diagnosis is of paramount importance to avoid unnecessary surgical operations and to implement the appropriate treatment mainly in the uncommon forms of HH, such as nesidioblastosis and autoimmune hypoglycaemia.

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Abbreviations

HH:

Hyperinsulinemic hypoglycaemia

pNET:

Pancreatic neuroendocrine tumour

SSTR:

Somatostatin receptors

INF-α :

Interferon-α

TAE:

Trans-arterial embolization

TACE:

Trans-arterial chemoembolization

SIRT:

Selective internal radiation therapy

PRRT:

Peptide receptor radionuclide therapy

NIPHS:

Noninsulinoma pancreatogenous hypoglycaemia syndrome

RYGB:

Roux-en-Y gastric bypass

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Acknowledgments

We would like to acknowledge the Nike Group: Manuela Albertelli, Emanuela Arvat, Roberto Baldelli, Alfredo Berruti, Antonio Bianchi, Lisa Bodei, Gerardo Botti, Francesco Corcione, Gianfranco Delle Fave, Laura De Marinis, Gaetano De Rosa, Antonella Di Sarno, Alessandra Dicitore, Nicola Fazio, Giuseppe Fanciulli, Piero Ferolla, Diego Ferone, Angelina Filice, Marco Gallo, Carla Giordano, Dario Giuffrida, Andrea Lania, Secondo Lastoria, Francesco Logoluso, Paola Loli, Pasqualino Malandrino, Marco Manzoni, Massimo Marchetti, Chiara Martini, Erika Messina, Roberta Modica, Cecilia Motta, Mauro Papotti, Stefano Partelli, Giovanni Persico, Alessandro Piovesan, Alfredo Pontecorvi, Valeria Ramundo, Paola Razzore, Francesca Rota, Francesco Scavuzzo, Concetta Sciammarella, Giovanni Vitale, Maria Chiara Zatelli.

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  1. Section of Endocrinology, Medicina Generale e Malattie Aterotrombotiche e Degenerative, Department of Medicine, University of Verona, Piazzale LA Scuro, Policlinico G.B. Rossi, 37134, Verona, Italy

    M. V. Davi′

  2. Internal Medicine I, Department of Clinical and Biological Sciences, University of Turin, San Luigi Hospital, Orbassano, Italy

    A. Pia

  3. Section of Endocrinology, Biomedical Department of Internal and Specialist Medicine (DIBIMIS), University of Palermo, Palermo, Italy

    V. Guarnotta

  4. Endocrinology Unit, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy

    G. Pizza & A. Colao

  5. Thyroid and Parathyroid Surgery Unit, Istituto Nazionale per lo Studio e la Cura dei Tumori “Fondazione G. Pascale” IRCCS, Naples, Italy

    A. Faggiano

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  1. M. V. Davi′
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  2. A. Pia
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  3. V. Guarnotta
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Consortia

On behalf of NIKE Group

  • Manuela Albertelli
  • , Emanuela Arvat
  • , Roberto Baldelli
  • , Alfredo Berruti
  • , Antonio Bianchi
  • , Lisa Bodei
  • , Gerardo Botti
  • , Francesco Corcione
  • , Gianfranco Delle Fave
  • , Laura De Marinis
  • , Gaetano De Rosa
  • , Antonella Di Sarno
  • , Alessandra Dicitore
  • , Nicola Fazio
  • , Giuseppe Fanciulli
  • , Piero Ferolla
  • , Diego Ferone
  • , Angelina Filice
  • , Marco Gallo
  • , Carla Giordano
  • , Dario Giuffrida
  • , Andrea Lania
  • , Secondo Lastoria
  • , Francesco Logoluso
  • , Paola Loli
  • , Pasqualino Malandrino
  • , Marco Manzoni
  • , Massimo Marchetti
  • , Chiara Martini
  • , Erika Messina
  • , Roberta Modica
  • , Cecilia Motta
  • , Mauro Papotti
  • , Stefano Partelli
  • , Giovanni Persico
  • , Alessandro Piovesan
  • , Alfredo Pontecorvi
  • , Valeria Ramundo
  • , Paola Razzore
  • , Francesca Rota
  • , Francesco Scavuzzo
  • , Concetta Sciammarella
  • , Giovanni Vitale
  •  & Maria Chiara Zatelli

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Correspondence to M. V. Davi′.

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M.V.D., A.P., V.G., G.P. declare that there is no conflict of interest. A.F. received speaker fees from Novartis and Ipsen; A.C. received research grants from Novartis, received speaker fees from Novartis and Ipsen and is a member of Novartis and Ipsen Advisory Board.

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Davi′, M.V., Pia, A., Guarnotta, V. et al. The treatment of hyperinsulinemic hypoglycaemia in adults: an update. J Endocrinol Invest 40, 9–20 (2017). https://doi.org/10.1007/s40618-016-0536-3

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