Endocrine Abstracts

Introduction: Isolated postprandial hyperinsulinaemic hypoglycaemia (PPHH) in the paediatric age has been exceptionally reported in the literature.

Objective: To describe the clinical and biochemical characteristics as well as the management of a cohort of children with isolated PPHH followed at a single tertiary paediatric centre.

Subjects and methods: Six children (three males) were collected. The clinical characteristics, diagnosis, management, and follow-up of patients with PPHH were retrospectively reviewed. The tests for diagnosis and monitoring were: 24 h blood glucose profile, continuous blood glucose monitoring system, diagnostic fast, prolonged oral glucose tolerance (OGTT) and mixed meal (MM). Management options included: dietary intervention, diazoxide and acarbose.

Results: Age ranged between 4.1 and 8.9 years at diagnosis, and auxology parameters in all children were within normality. Fasting tolerance was normal in all the patients, but a prolonged OGTT showed symptomatic hypoglycaemia (blood glucose <3.5 mmol/l) after 120 minutes with simultaneous detectable serum insulin concentrations. The mean follow-up was of 3.3±3.1 years. Acarbose was started in four patients, demonstrating a favourable glycaemic and symptom–control effect, but only one patient remained on it on the long-term due to its side effects. Diazoxide was useful in one patient. The rest of the patients were managed on frequent feeds although, despite being on this, prolonged OGTT/MM evidenced persisting PPHH. Two patients spontaneously grew out of the condition on follow-up investigations.

Conclusions: Recognising hypoglycaemia in PPHH requires a prolonged OGTT. In those children with PPHH tried on acarbose, this proved to be beneficial although poorly tolerated. Patients managed exclusively on frequent feeds did demonstrate ongoing hypoglycaemia on prolonged OGTT. The aetiology of PPHH in these patients still needs to be deciphered.