Endocrine Abstracts

Background: Congenital hyperinsulinism (CHI) is the most common cause of persistent hypoglycemia in infancy. The two main histological types, diffuse and focal, are clinically identical but differ in underlying genetic mechanisms, histopathology, and management. Fluorine-18 L-3,4-dihydroxyphenylalanine positron emission tomography/computed tomography (18F-DOPA PET/CT) can help differentiate focal from diffuse CHI and consequently aid in patient management. At our institution, a protocol has been developed to perform 18F-DOPA PET/CT under oral sedation with chloral hydrate in children with CHI, to avoid the use of general anaesthesia (GA).

Objective: To assess the safety and efficacy of oral sedation in children undergoing 18F-DOPA PET/CT to differentiate focal and diffuse disease.

Design: A retrospective case note review was conducted to determine whether oral sedation for 18F-DOPA PET/CT resulted in sufficient image quality for interpretation and to identify any adverse effects associated with the procedure.

Results: Between 2010 and 2023, seventy-eight patients aged 0.07 to 18.2 years underwent 18F-DOPA PET/CT. Oral sedation was used in 71 patients (90%), with weights ranging from 3.65 to 56.75 kg at the time of the scan. All scans performed under oral sedation produced images of sufficient quality for interpretation. No patients required a subsequent scan under general anaesthesia, though one patient underwent elective GA due to concerns about potential airway obstruction. Six patients (8%), all older than 10.5 years, tolerated the procedure without sedation. No post-procedure complications were documented.

Conclusion: Oral sedation can be considered as an alternative to general anaesthesia for children undergoing 18F-DOPA PET/CT for the investigation of CHI, provided there are no contraindications in the patient’s history or examination findings. 18F-DOPA PET/CT can be effectively performed using oral chloral hydrate sedation in these cases.