Idiopathic postprandial hyperinsulinaemic hypoglycaemia
-
Maria Güemes
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.
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.
References
1. Middleton SJ, Balan K. Idiopathic accelerated gastric emptying presenting in adults with post-prandial diarrhea and reactive hypoglycemia: a case series. J Med Case Rep 2012;6:1752–947.10.1186/1752-1947-6-132Suche in Google Scholar
2. Hofeldt FD. Reactive hypoglycemia. Endocrinol Metab Clin North Am 1989;18:185–201.10.1016/S0889-8529(18)30396-7Suche in Google Scholar
3. Sorensen M, Johansen OE. Idiopathic reactive hypoglycaemia – prevalence and effect of fibre on glucose excursions. Scand J Clin Lab Invest 2010;70:385–91.10.3109/00365513.2010.491869Suche in Google Scholar
4. Brun JF, Fedou C, Mercier J. Postprandial reactive hypoglycemia. Diabetes Metab 2000;26:337–51.Suche in Google Scholar
5. Lefebvre PJ, Andreani D, Marks V, Creutzfeldt W. Statement on postprandial hypoglycemia: Diabetes Care 1988;11:439–40.10.2337/diacare.11.5.439bSuche in Google Scholar
6. Luyckx AS, Lefebvre PJ. Plasma insulin in reactive hypoglycemia. Diabetes 1971;20:435–42.10.2337/diab.20.6.435Suche in Google Scholar
7. Owada K, Wasada T, Miyazono Y, Yoshino H, Hasumi S, et al. Highly increased insulin secretion in a patient with postprandial hypoglycemia: role of glucagon-like peptide-1 (7-36) amide. Endocr J 1995;42:147–51.10.1507/endocrj.42.147Suche in Google Scholar
8. Leonetti F, Foniciello M, Iozzo P, Riggio O, Merli M, et al. Increased nonoxidative glucose metabolism in idiopathic reactive hypoglycemia. Metabolism 1996;45:606–10.10.1016/S0026-0495(96)90031-1Suche in Google Scholar
9. Brun JF, Bouix O, Monnier JF, Blachon C, Jourdan N, et al. Increased insulin sensitivity and basal insulin effectiveness in postprandial reactive hypoglycaemia. Acta Diabetol 1996;33:1–6.10.1007/BF00571932Suche in Google Scholar PubMed
10. Berlin I, Grimaldi A, Landault C, Cesselin F, Puech AJ. Suspected postprandial hypoglycemia is associated with beta-adrenergic hypersensitivity and emotional distress. J Clin Endocrinol Metab 1994;79:1428–33.10.1210/jcem.79.5.7962339Suche in Google Scholar
11. Senniappan S, Shanti B, James C, Hussain K. Hyperinsulinaemic hypoglycaemia: genetic mechanisms, diagnosis and management. J Inherit Metab Dis 2012;35:589–601.10.1007/s10545-011-9441-2Suche in Google Scholar PubMed
12. Samuk I, Afriat R, Horne T, Bistritzer T, Barr J, et al. Dumping syndrome following Nissen fundoplication, diagnosis, and treatment. J Pediatr Gastroenterol Nutr 1996;23:235–40.10.1097/00005176-199610000-00006Suche in Google Scholar PubMed
13. Stanley CA, Lieu YK, Hsu BY, Burlina AB, Greenberg CR, et al. Hyperinsulinism and hyperammonemia in infants with regulatory mutations of the glutamate dehydrogenase gene. N Engl J Med 1998;338:1352–7.10.1056/NEJM199805073381904Suche in Google Scholar PubMed
14. Senniappan S, Pitt K, Shah P, Arya V, Jaiswal S, et al. Postprandial hyperinsulinaemic hypoglycaemia secondary to a congenital portosystemic shunt. Horm Res Paediatr 2015;21:21.10.1159/000369014Suche in Google Scholar PubMed
15. Calabria AC, Gallagher PR, Simmons R, Blinman T, De Leon DD. Postoperative surveillance and detection of postprandial hypoglycemia after fundoplasty in children. J Pediatr 2011;159:597–601.10.1016/j.jpeds.2011.03.049Suche in Google Scholar PubMed PubMed Central
16. Rivkees SA, Crawford JD. Hypoglycemia pathogenesis in children with dumping syndrome. Pediatrics 1987;80:937–42.10.1542/peds.80.6.937Suche in Google Scholar
17. Palladino AA, Sayed S, Levitt Katz LE, Gallagher PR, De Leon DD. Increased glucagon-like peptide-1 secretion and postprandial hypoglycemia in children after Nissen fundoplication. J Clin Endocrinol Metab 2009;94:39–44.10.1210/jc.2008-1263Suche in Google Scholar PubMed PubMed Central
18. Toft-Nielsen M, Madsbad S, Holst JJ. Exaggerated secretion of glucagon-like peptide-1 (GLP-1) could cause reactive hypoglycaemia. Diabetologia 1998;41:1180–6.10.1007/s001250051049Suche in Google Scholar PubMed
19. Holdsworth CD, Turner D, McIntyre N. Pathophysiology of post-gastrectomy hypoglycaemia. Br Med J 1969;4:257–9.10.1136/bmj.4.5678.257Suche in Google Scholar PubMed PubMed Central
20. Khoshoo V, Reifen RM, Gold BD, Sherman PM, Pencharz PB. Nutritional manipulation in the management of dumping syndrome. Arch Dis Child 1991;66:1447–8.10.1136/adc.66.12.1447Suche in Google Scholar PubMed PubMed Central
21. Borovoy J, Furuta L, Nurko S. Benefit of uncooked cornstarch in the management of children with dumping syndrome fed exclusively by gastrostomy. Am J Gastroenterol 1998;93:814–8.10.1111/j.1572-0241.1998.231_a.xSuche in Google Scholar PubMed
22. Ozgen AG, Hamulu F, Bayraktar F, Cetinkalp S, Yilmaz C, et al. Long-term treatment with acarbose for the treatment of reactive hypoglycemia. Eat Weight Disord 1998;3:136–40.10.1007/BF03340001Suche in Google Scholar PubMed
23. Salvatore T, Giugliano D. Pharmacokinetic-pharmacodynamic relationships of Acarbose. Clin Pharmacokinet 1996;30:94–106.10.2165/00003088-199630020-00002Suche in Google Scholar PubMed
24. Peter S. Acarbose and idiopathic reactive hypoglycemia. Horm Res 2003;60:166–7.10.1159/000073227Suche in Google Scholar PubMed
25. Ng DD, Ferry RJ, Jr., Kelly A, Weinzimer SA, Stanley CA, et al. Acarbose treatment of postprandial hypoglycemia in children after Nissen fundoplication. J Pediatr 2001;139:877–9.10.1067/mpd.2001.119169Suche in Google Scholar PubMed
26. De Cunto A, Barbi E, Minen F, Ventura A. Safety and efficacy of high-dose acarbose treatment for dumping syndrome. J Pediatr Gastroenterol Nutr 2011;53:113–4.10.1097/MPG.0b013e31820ae6d1Suche in Google Scholar PubMed
27. Zung A, Zadik Z. Acarbose treatment of infant dumping syndrome: extensive study of glucose dynamics and long-term follow-up. J Pediatr Endocrinol Metab 2003;16:907–15.10.1515/JPEM.2003.16.6.907Suche in Google Scholar
28. Thondam SK, Nair S, Wile D, Gill GV. Diazoxide for the treatment of hypoglycaemic dumping syndrome. Qjm 2013;106:855–8.10.1093/qjmed/hcr234Suche in Google Scholar PubMed
29. Al-Hussaini A, Butzner D. Therapeutic applications of octreotide in pediatric patients. Saudi J Gastroenterol 2012;18:87–94.10.4103/1319-3767.93807Suche in Google Scholar PubMed PubMed Central
30. Geer RJ, Richards WO, O’Dorisio TM, Woltering EO, Williams S, et al. Efficacy of octreotide acetate in treatment of severe postgastrectomy dumping syndrome. Ann Surg 1990;212: 678–87.10.1097/00000658-199012000-00005Suche in Google Scholar PubMed PubMed Central
31. Ohlbaum P, Galperine RI, Demarquez JL, Vergnes P, Martin C. Use of a long-acting somatostatin analogue (SMS 201-995) in controlling a significant ileal output in a 5-year-old child. J Pediatr Gastroenterol Nutr 1987;6:466–70.10.1097/00005176-198705000-00026Suche in Google Scholar PubMed
32. Hasler WL, Soudah HC, Owyang C. Mechanisms by which octreotide ameliorates symptoms in the dumping syndrome. J Pharmacol Exp Ther 1996;277:1359–65.10.1016/S0022-3565(25)13083-8Suche in Google Scholar
33. Lembcke B, Creutzfeldt W, Schleser S, Ebert R, Shaw C, et al. Effect of the somatostatin analogue sandostatin (SMS 201-995) on gastrointestinal, pancreatic and biliary function and hormone release in normal men. Digestion 1987;36:108–24.10.1159/000199408Suche in Google Scholar PubMed
34. Giugliano D, Luyckx A, Binder D, Lefebvre P. Comparative effects of metformin and indanorex in the treatment of reactive hypoglycemia. Int J Clin Pharmacol Biopharm 1979;17:76–81.Suche in Google Scholar
35. Arii K, Ota K, Suehiro T, Ikeda Y, Nishimura K, et al. Pioglitazone prevents reactive hypoglycemia in impaired glucose tolerance. Diabetes Res Clin Pract 2005;69:305–8.10.1016/j.diabres.2005.01.004Suche in Google Scholar PubMed
36. Dura Trave T, Moya Benavent M. [Recurrent post-prandial hypoglycemia: reactive hypoglycemia during childhood? The use of acarbose]. An Esp Pediatr 1999;51:77–80.Suche in Google Scholar
37. Poon M, Hussain K. Postprandial hyperinsulinaemic hypoglycaemia and type 1 diabetes mellitus. BMJ Case Rep 2009;10:8.10.1136/bcr.10.2008.1174Suche in Google Scholar PubMed PubMed Central
38. Virally ML, Guillausseau PJ. Hypoglycemia in adults. Diabetes Metab 1999;25:477–90.Suche in Google Scholar
39. Brun JF, Fedou C, Bouix O, Raynaud E, Orsetti A. Evaluation of a standardized hyperglucidic breakfast test in postprandial reactive hypoglycaemia. Diabetologia 1995;38:494–501.10.1007/BF00410289Suche in Google Scholar PubMed
40. Kieffer TJ, Habener JF. The glucagon-like peptides. Endocr Rev 1999;20:876–913.10.1210/edrv.20.6.0385Suche in Google Scholar PubMed
41. Service FJ. Hypoglycemia and the postprandial syndrome. N Engl J Med 1989;321:1472–4.10.1056/NEJM198911233212109Suche in Google Scholar PubMed
©2016 Walter de Gruyter GmbH, Berlin/Boston
Artikel in diesem Heft
- Frontmatter
- Original Articles
- Decreased undercarboxylated osteocalcin in children with type 2 diabetes mellitus
- Evaluation of left and right ventricular functions using conventional and tissue Doppler echocardiography in children with type 1 diabetes mellitus
- Prevalence of psychosocial morbidity in children with type 1 diabetes mellitus: a survey from Northern India
- Increased GLP-1 response to oral glucose in pre-pubertal obese children
- Prevalence of idiopathic intracranial hypertension and associated factors in obese children and adolescents
- Idiopathic postprandial hyperinsulinaemic hypoglycaemia
- Feeding, eating and behavioral disturbances in Prader-Willi syndrome and non-syndromal obesity
- Interpretation of thyroid glands in a group of healthy children: real-time ultrasonography elastography study
- Ghrelin, insulin-like growth factor I and adipocytokines concentrations in born small for gestational age prepubertal children after the catch-up growth
- Zoledronate for Osteogenesis imperfecta: evaluation of safety profile in children
- Elevated serum adiponectin is related to elevated serum ferritin and interleukin-6 in β-thalassaemia major children
- GCK mutations in Chinese MODY2 patients: a family pedigree report and review of Chinese literature
- Cystinosis in Eastern Turkey
- Microarray analysis of slipped capital femoral epiphysis growth plates
- Case Reports
- Autoimmune polyendocrinopathy-candidiasis-ectodermal dystrophy: report of three cases from Iran
- Type 1 diabetes and GAD65 limbic encephalitis: a case report of a 10-year-old girl
- A novel splice site mutation in the GNPTAB gene in an Iranian patient with mucolipidosis II α/β
- Parent observed neuro-behavioral and pro-social improvements with oxytocin following surgical resection of craniopharyngioma
- A fatal outcome of complicated severe diabetic ketoacidosis in a 11-year-old girl
Artikel in diesem Heft
- Frontmatter
- Original Articles
- Decreased undercarboxylated osteocalcin in children with type 2 diabetes mellitus
- Evaluation of left and right ventricular functions using conventional and tissue Doppler echocardiography in children with type 1 diabetes mellitus
- Prevalence of psychosocial morbidity in children with type 1 diabetes mellitus: a survey from Northern India
- Increased GLP-1 response to oral glucose in pre-pubertal obese children
- Prevalence of idiopathic intracranial hypertension and associated factors in obese children and adolescents
- Idiopathic postprandial hyperinsulinaemic hypoglycaemia
- Feeding, eating and behavioral disturbances in Prader-Willi syndrome and non-syndromal obesity
- Interpretation of thyroid glands in a group of healthy children: real-time ultrasonography elastography study
- Ghrelin, insulin-like growth factor I and adipocytokines concentrations in born small for gestational age prepubertal children after the catch-up growth
- Zoledronate for Osteogenesis imperfecta: evaluation of safety profile in children
- Elevated serum adiponectin is related to elevated serum ferritin and interleukin-6 in β-thalassaemia major children
- GCK mutations in Chinese MODY2 patients: a family pedigree report and review of Chinese literature
- Cystinosis in Eastern Turkey
- Microarray analysis of slipped capital femoral epiphysis growth plates
- Case Reports
- Autoimmune polyendocrinopathy-candidiasis-ectodermal dystrophy: report of three cases from Iran
- Type 1 diabetes and GAD65 limbic encephalitis: a case report of a 10-year-old girl
- A novel splice site mutation in the GNPTAB gene in an Iranian patient with mucolipidosis II α/β
- Parent observed neuro-behavioral and pro-social improvements with oxytocin following surgical resection of craniopharyngioma
- A fatal outcome of complicated severe diabetic ketoacidosis in a 11-year-old girl
