Endocrine Abstracts

Background: Newborn infants have multiple risk factors for developing hypoglycaemia of which, hyperinsulinism is an important cause of both transient and persistent hyperinsulinaemic hypoglycaemia (HH). It can present in newborns infants at term, preterm and newborns with intrauterine growth retardation (IUGR). There have been no previous reports of HH occurring in twins and triplets.

Aims and objectives: We report the occurrence of HH in 4 sets of twins and one set of triplets where HH was present in only one of the twin and not the other twin.

Methods: Clinical and biochemical data was collected retrospectively from case notes and electronic patient records over a period of 6 years for patients referred to the Centre for Hyperinsulinism at Great Ormond Street Children’s Hospital.

Results: Four sets of twins and one set of triplets were identified with HH (two dizygotic and three monozygotic). The mean gestational age of all newborns was 37 weeks, the mean birth weight of the affected twins was 2280 g and the mean birth weight of the unaffected twins was 2450 g (P value 0.537). The age at presentation of hypoglycaemia was day 1. All infants responded to treatment with diazoxide (dose 3–5 mg/kg per day), started at a mean age of 12 days (3–25 range) with mean duration of 5 months.

Conclusion: This is the first study to report the occurrence of HH in twins and triplets. There was no significant difference in the birth weights of the twin with HH and the twin without HH. This suggests that the low birth weight may not be the only reason for the onset of HH. All infants responded well to diazoxide, suggesting that the occurrence of HH in these groups is transient. Further research is required to understand the mechanisms that lead to HH in such groups of patients.