Objective: Postprandial hyperinsulinaemic hypoglycaemia (PPHH) or “late dumping syndrome” is a well-recognised complication following gastrointestinal surgery and has been less commonly identified idiopathically in paediatric patients. This study describes and compares the characteristics, diagnosis, management and outcomes of paediatric idiopathic and surgical PPHH.
Design: Retrospective chart review of children (≤ 18-year-old) at a single tertiary paediatric hospital diagnosed with PPHH between 2003 and 2018.
Method: Cases of PPHH were identified from the Endocrinology unit database. Demographics, method of diagnosis, management and outcomes were evaluated. Diagnostic tests included standard/prolonged oral glucose tolerance test (OGTT/POGTT), mixed meal test (MMT) and feed test (FT). Demographic data were summarised using standard descriptive statistics. Continuous and discrete variables were analysed using unpaired t-tests. Statistical significance was defined as P value <0.05.
Results: 34 children, 18 idiopathic and 16 surgical (Post-gastrointestinal surgery), were diagnosed and managed for PPHH. 41% of cases had a family history of diabetes mellitus or hypoglycaemia and 24% had a history of resolved perinatal hypoglycaemia. Idiopathic patients had a significantly longer duration of symptoms prior to diagnosis (2.54 vs 0.18 years, P=0.0009). 71% of PPHH were diagnosed on OGTT/POGTT and 18% of cases required repeat testing. Change in feed regimen was the most common intervention, utilised in 88%. 79% of cases required management with corn-starch or other medications. 8 patients (24%) required >1 medication and the mean number of medications was higher in surgical PPHH (1.4 vs 0.83, P=0.04). Acarbose was the most common medication, used in 20 of patients, and improved glycaemic control in 80%. Diazoxide was used in 10 and improved control in 50%. Patients were followed up for an average of 4.0 years (±3.4). 18 (53%) had improved glycaemic control and nine (26%) had no hypoglycaemic episodes on treatment. Resolution occurred in 12% taking from 1.54-5.54 years.
Conclusion: This study is the first and largest to describe and compare paediatric surgical and idiopathic PPHH. Diagnosis of PPHH was often delayed, particularly in idiopathic PPHH, and prolonged or repeated testing may be required in patients with a consistent history. PPHH tended to be more aggressively managed in surgical PPHH, with more medications trialled and stricter feeding regimens, but had better outcomes. Acarbose and diazoxode can be considered as medical agents in those with refractory hypoglycaemia, although use of both were limited by side-effects. PPHH improved in the majority of children but resolution was uncommon in our population.
15 Sep 2022 - 17 Sep 2022