Background: Only a few case reports have described isolated postprandial hyperinsulinaemic hypoglycaemia (PPHH) in children.
Objectives: To describe a single tertiary paediatric centres experience in the management of isolated PPHH.
Patients and methods: Six children (three females) were identified. A retrospective review of the clinical characteristics, diagnosis, management and follow-up of patients with PPHH was performed. Investigations included: 24 h glucose profile, continuous glucose monitoring system, diagnostic fast, prolonged oral glucose tolerance test (OGTT) and mixed meal (MM) test. Management options were: dietary intervention, diazoxide and acarbose.
Results: At diagnosis ages were between 4.1 and 8.9 years and all children had auxology parameters within the normal range. All the patients showed a normal fasting tolerance but a prolonged OGTT demonstrated symptomatic hypoglycaemia (blood glucose <3.5 mmol/l) after 120 min with simultaneous detectable serum insulin concentrations. The mean follow-up was of 3.3±3.1 years. Four patients were tried on acarbose, which had a positive glycaemic and symptom-control effect, but due to its side effects, only one patient remained on it on the long-term. One patient responded to diazoxide. The other patients were managed on frequent feeds but, even on this, prolonged OGTT/MM demonstrated persisting PPHH. On follow-up two patients spontaneously grew out of the condition.
Conclusions: The identification of hypoglycaemia in PPHH requires a prolonged OGTT. Acarbose was beneficial in children with PPHH, although it was poorly tolerated. Hypoglycaemia persisted on prolonged OGTT in those patients managed exclusively on frequent feeds. The cause of the PPHH in these patients still needs to be elucidated.
01 - 03 Oct 2015
European Society for Paediatric Endocrinology