Idiopathic postprandial hyperinsulinaemic hypoglycaemia

Maria Güemes; Maria Melikyan; Senthil Senniappan; Khalid Hussain

doi:10.1515/jpem-2016-0043

Article

Idiopathic postprandial hyperinsulinaemic hypoglycaemia

Maria Güemes , Maria Melikyan , Senthil Senniappan and Khalid Hussain

Published/Copyright: May 25, 2016

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From the journal Journal of Pediatric Endocrinology and Metabolism Volume 29 Issue 8

Abstract

Background:

Idiopathic postprandial hyperinsulinaemic hypoglycaemia (PPHH) has rarely been reported in the paediatric age. The objective of this study was to describe the clinical characteristics, diagnosis and management in a group of children with PPHH.

Methods:

Six children (three females) with a mean follow-up of 3.5±3.0 years at a single tertiary paediatric hospital. All had 24-h blood glucose monitoring, diagnostic fast and prolonged oral glucose tolerance test (OGTT). Follow-up included: 24-h blood glucose monitoring or continuous glucose monitoring system, prolonged OGTT and/or mixed meal (MM) test.

Results:

Age at diagnosis ranged from 5.4 to 15.7 years and auxology parameters were within normal range in all subjects. All the children had a normal fasting tolerance for age. Prolonged OGTT demonstrated symptomatic hypoglycaemia after 120 min in all the patients with simultaneous detectable serum insulin concentration. Acarbose was tried in three patients, having a positive effect on glycaemic and symptom control, but due to side effects, only two patients continued acarbose in the long run. Diazoxide proved to be beneficial in one patient. The rest of the patients were managed with frequent feeds but despite this, prolonged OGTT/MM demonstrated on-going PPHH.

Conclusions:

Prolonged OGTT is necessary to diagnose PPHH in children. Acarbose is beneficial in children with PPHH, although not well tolerated. Patients managed exclusively on frequent feeds demonstrated persistent hypoglycaemia on OGTT. The underlying cause of the PPHH in these patients remains unknown.

Keywords: acarbose; dumping syndrome; hyperinsulinaemic hypoglycaemia; oral glucose; tolerance test; postprandial hypoglycaemia

Corresponding author: Professor Khalid Hussain, Developmental Endocrinology Research Group/Clinical Molecular Genetics Unit, UCL Institute of Child Health and Great Ormond Street Hospital for Children, 30 Guilford Street, London WC1N 1EH, UK, Phone: +442079052128, Fax: +442079052832

Author contributions: All the authors have accepted responsibility for the entire content of this submitted manuscript and approved submission.
Research funding: None declared.
Employment or leadership: None declared.
Honorarium: None declared.
Competing interests: The funding organization(s) played no role in the study design; in the collection, analysis, and interpretation of data; in the writing of the report; or in the decision to submit the report for publication.

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Received: 2016-2-4

Accepted: 2016-4-19

Published Online: 2016-5-25

Published in Print: 2016-8-1

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https://doi.org/10.1515/jpem-2016-0043

Keywords for this article

acarbose; dumping syndrome; hyperinsulinaemic hypoglycaemia; oral glucose; tolerance test; postprandial hypoglycaemia