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THE HYPERINSULINEMIC HYPOGLYCEMIA IN INFANTS AND CHILDREN. A STUDY ON 9 CASES

Circulating levels of blood glucose, immunoreactive insulin (IRI) and C-peptide immunoreactivity (CPR) were measured in 6 infants (4 had islet cell adenoma and 2 had nesidioblastosis) and 3 children (all had islet cell adenoma) with hyperinsulinemic hypoglycemia. The ratio blood glucose : insulin on several days had high value for diagnosis of hyperinsulinemic hypoglycemia. The oral glucose load gave variable results, and the arginine infusion was without abnormality of hormone secretion. After intravenous administration of somatostatin, the suppression of CPR was more prominent than the inhibition of IRI. Hormone secretion after diazoxide infusion ranging from paradoxic stimulation to transient decrease of IRI or CPR. Intravenous injection of actrapid results in suppression of CPR secretion in most cases. In two patients we could diagnosed the pancreatic distribution, by measuring IRI in the portal blood, preoperatively.It is suggested, that the various stimulation or suppression tests do not differentiate hyperinsulinism caused by an islet cell adenoma, from that, caused by nesidioblastosis of the pancreas.