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LETTER TO THE EDITOR
Year : 2013  |  Volume : 18  |  Issue : 2  |  Page : 92
 

Comment on persistent hyperinsulinemic hypoglycemia of infancy


1 Department of Pediatrics, Prabhakar Kore Hospital and Medical Research Centre, KLE University's Jawaharlal Nehru Medical College, Belgaum, Karnataka, India
2 Department of Pediatric Surgery, Prabhakar Kore Hospital and Medical Research Centre, KLE University's Jawaharlal Nehru Medical College, Belgaum, Karnataka, India

Date of Web Publication21-Mar-2013

Correspondence Address:
G P Prashanth
Department of Pediatrics, Jawaharlal Nehru Medical College, Nehru Nagar, Belgaum - 590 010, Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0971-9261.109366

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How to cite this article:
Prashanth G P, Kurbet SB. Comment on persistent hyperinsulinemic hypoglycemia of infancy. J Indian Assoc Pediatr Surg 2013;18:92

How to cite this URL:
Prashanth G P, Kurbet SB. Comment on persistent hyperinsulinemic hypoglycemia of infancy. J Indian Assoc Pediatr Surg [serial online] 2013 [cited 2019 Nov 12];18:92. Available from: http://www.jiaps.com/text.asp?2013/18/2/92/109366


Sir,

We read with interest an excellent review of persistent hyperinsulinemic hypoglycemia of infancy (PHHI) by Goel and Chaudhury, recently published in the journal. [1] We would like to highlight few relevant points that may be useful to the readers.

Firstly, the authors did not comment on the cases of PHHI reported from India. After a thorough literature search, we could find less than 25 cases of congenital hyperinsulinism reported in the Indian pediatric literature. [2],[3] Only one article reported familial clustering of eight cases in 1998. [2] A recent paper reported identification of ABCC8 splicing mutation. [3] Considering the higher incidence of PHHI in communities with a high rate of consanguinity, it is possible that many cases in our country go unreported due to lack of adequate facilities for work-up. We recently came across such a case (a 25-day old-term neonate with persistent hyperinsulinemic hypoglycemia) wherein positron emission tomography (PET) scan was not possible due to lack of the facility. However, in view of intractable hypoglycemia, we proceeded with surgery following laboratory documented hyperinsulinemia during an episode of hypoglycemia. The resected pancreatic specimen showed diffuse hyperplasia of beta islet cells on histology. Near-total pancreatectomy was successful in relieving symptomatic hypoglycemia in our case.

Secondly, though 18F-dopa-positron emission tomography (PET) scan has been a highly sensitive tool in diagnosing PHHI, recent findings suggest that in as many as 36% cases it may be inaccurate in defining the location or size of the lesion, or both location and size, leading to inaccurate pancreatic resection. [4] A recent Japanese report also made similar observations and the authors suggested the use of 'pancreatic percentage' expressing the uptake of the head, body or tail as a percentage of the total maximum standardized uptake value of the whole gland to improve accuracy. [5]

Thirdly, there are several reports in the recent literature suggesting the coexistence of ectopic (extra-pancreatic) foci of nesidioblastosis with one such instance responsible for failure of surgery and need for continued medical line of management despite multiple pancreatectomies. [6] However, 18F-dopa-PET scan can delineate the presence of such ectopic foci preoperatively and help in surgical excision of such lesions.

We thought the above stated points are worth mentioning though the review specifically highlighted the current concepts in PHHI. These reports are preliminary but it is important for the treating medical-surgical teams to bear in mind these emerging potential drawbacks of preoperative PET scan and the coexistence of ectopic foci of nesidioblastosis. One should note that intraoperative histological confirmation is invariably needed in both these instances. Studies further characterizing persistent hyperinsulinemic hypoglycemia of infancy in Indian population are warranted.

 
   References Top

1.Goel P, Chaudury SR. Persistent hyperinsulinemic hypoglycemia of infancy: An overview of current concepts. J Indian Assoc Pediatr Surg 2012;17:99-103.  Back to cited text no. 1
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2.Desai MP, Khatri JV. Persistent hyperinsulinemic hypoglycemia of infancy. Indian Pediatr 1998;35:317-28.  Back to cited text no. 2
    
3.Yadav D, Dhingra B, Kumar S, Kumar V, Dutta AK. Persistent hyperinsulinemic hypoglycemia of infancy. J Pediatr Endocrinol Metab 2012;25:591-3.  Back to cited text no. 3
    
4.Zani A. The predictive value of preoperative fluorine-18-L-3, 4-dihydroxyphenylalanine positron emission tomography-computed tomography scans in children with congenital hyperinsulinism of infancy. J Pediatr Surg 2011;46:204-8.  Back to cited text no. 4
    
5.Masue M, Nishibori H, Fukuyama S, Yoshizawa A, Okamoto S, Doi R, et al. Diagnostic accuracy of [ [18] F]-fluoro-L-dihydroxyphenylalanine positron emission tomography scan for persistent congenital hyperinsulinism in Japan. Clin Endocrinol (Oxf) 2011;75:342-6.  Back to cited text no. 5
    
6.Hussain K, Seppänen M, Näntö-Salonen K, Adzick NS, Stanley CA, Thornton P, et al. The diagnosis of ectopic focal hyperinsulinism of infancy with [18F]-dopa positron emission tomography. J Clin Endocrinol Metab 2006;91:2839-42.  Back to cited text no. 6
    




 

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