Treatment of hyperinsulinemic hypoglycemia because of diffuse nesidioblastosis with nifedipine after surgical therapies in a newborn
-
Esad Koklu
,
Keramettin Uğur Ozkan
Abstract
Recent studies have demonstrated a role for calcium channel blocking agents in the treatment of persistent hyperinsulinemic hypoglycemia of newborns. We report a newborn infant with persistent hyperinsulinemic hypoglycemia whom we successfully treated with oral nifedipine alone after surgical therapies. A 4-day-old male infant was referred with intractable hypoglycemia and seziures. Normoglycaemia could be maintained only by the intravenous infusion of glucose at a rate of 20 mg/kg per minute. Persistent hyperinsulinemic hypoglycemia of newborn was diagnosed from an inappropriately raised plasma insulin concentration (44 mU/L) at the time of hypoglycemia. Medical treatments led to only a mild reduction in the intravenous glucose requirement; an 85–90% pancreatectomy was performed and histological “diffuse nesidioblastosis” was confirmed. However, despite all the medical treatments after the first pancreatectomy, the hyperinsulinemic hypoglycemia persisted and a second 95% pancreatectomy was performed. After the second pancreatectomy, persistent hyperinsulinemic hypoglycemia was treated with somatostatin and diazoxide, but led to no reduction in the intravenous glucose requirement. We report the case of an infant who had persistent hypoglycemia after two subtotal pancreatic resections but subsequently became normoglycemic on treatment with nifedipine (2 mg/kg per day). The patient was discharged home on oral nifedipine. Calcium channel blocking agents cuold be used with efficacy and safety in recurrent persistent hyperinsulinemic hypoglycemia.
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©2013 by Walter de Gruyter Berlin Boston
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Articles in the same Issue
- Masthead
- Masthead
- Review article
- Application of imaging modalities for evaluating neuroblastoma
- Images in pediatric endocrinology
- Lingual thyroid
- Original articles
- A levothyroxine dose recommendation for the treatment of children and adolescents with autoimmune thyroiditis induced hypothyroidism
- Fasting glucagon-like peptide-1 in patients with overt hyperthyroidism and euthyroid congenital hypothyroidism
- Perinatal complications and higher risks of offspring thyroid dysfunction in early childhood of Graves’ disease mothers with euthyroidism
- Clinical characteristics and management of cranial diabetes insipidus in infants
- Desmopressin administration in children with central diabetes insipidus: a retrospective review
- An electronic surveillance system for monitoring the hospital presentation of nutritional vitamin D deficiency in children in Scotland
- Frequency and severity of ketoacidosis at onset of autoimmune type 1 diabetes over the past decade in children referred to a tertiary paediatric care centre: potential impact of a national programme highlighted
- Vitamin D status is associated with early markers of cardiovascular disease in prepubertal children
- Evaluation of bone mineral density in children with type 1 diabetes mellitus
- Observational study of diabetes management in type 1 diabetic school-age children during holiday versus school days
- Relationship of body mass index and GAD65 antibody status on β-cell secretion at diabetes onset in African-American children
- Serum dipeptidyl peptidase 4 activity in children with type 1 diabetes mellitus
- Concomitant autoantibodies in newly diagnosed diabetic children with transient celiac serology or proven celiac disease
- Assessment of user-friendliness of the Norditropin FlexPro for pediatric patients treated with recombinant human growth hormone: results of an open-label user survey
- Cognitive impairment and gray/white matter volume abnormalities in pediatric patients with Turner syndrome presenting with various karyotypes
- Prevalence of metabolic syndrome among urban Indian adolescents and its relation with insulin resistance (HOMA-IR)
- Prevalence of metabolic syndrome in obese Chilean children and association with gene variants of the leptin-melanocortin system
- Evaluation of serum neopterin levels and its relationship with adipokines in pediatric obesity-related nonalcoholic fatty liver disease and healthy adolescents
- Could GSD type I expand the spectrum of disorders with elevated plasma chitotriosidase activity?
- Patient reports
- Treatment of hyperinsulinemic hypoglycemia because of diffuse nesidioblastosis with nifedipine after surgical therapies in a newborn
- Successful subcutaneous glucagon use for persistent hypoglycaemia in congenital hyperinsulinism
- A novel atypical presentation of insulin autoimmune syndrome (Hirata’s disease) in a child
- Diagnosis of septo-optic dysplasia in a neonate with hypernatremia, hypoglycemia, and persistent hypothermia
- Speech and language delay in two children: an unusual presentation of hyperthyroidism
- Lissencephaly presenting with congenital hypothyroidism
- PHEX gene mutation in a Chinese family with six cases of X-linked hypophosphatemic rickets
- Primary hyperparathyroidism as an extremely rare cause of secondary myelofibrosis in childhood
- A family with Camurati-Engelman disease: the role of the missense p.R218C mutation in TGFbeta1 in bones and endocrine glands
- A case of SCNN1A splicing mutation presenting as mild systemic pseudohypoaldosteronism type 1
- Central precocious puberty in a girl with Prader-Willi syndrome
- Type 1 diabetes mellitus in a patient with homozygous sickle cell anemia
- Short communication
- No impact of obesity susceptibility loci on weight regain after a lifestyle intervention in overweight children
- Letter to the Editor
- Reliability and validity of homeostasis model assessment for insulin resistance and β-cell dysfunction in critically ill children with hyperglycemia
