HYPERINSULINISM IN CHILDREN - DIAGNOSTIC-VALUE OF PANCREATIC VENOUS SAMPLING CORRELATED WITH CLINICAL, PATHOLOGICAL AND SURGICAL OUTCOME IN25 CASES

Neonatal hypoglycemia represents an emergency of heterogeneous etiolog y. The occurrence of persistent hypoglycemia caused by hyperinsulinism has not been well established. Some authors claim that it may be more common than previously suggested. The diagnostic goal is to distingui sh hyperinsulinemia from other causes of hypoglycemia because manageme nt strategies differ. The diagnosis of persistent hypoglycemia attribu table to hyperinsulinism is made when insulin secretion is excessive o r inappropriate (> 10 mu IU/ml). Medical management includes frequent feeding, high hydrocarbon intake, glucagon, diazoxide, somatostatin or steroid treatment. In case of resistance to medical intervention, sur gery consisting of subtotal pancreatectomy is performed to avoid neuro logical sequelae, However, pediatric organic hypoglycemia secondary to hyperinsulinism can be caused by either diffuse or focal pancreatic l esions. Differentiation between these two types of lesion is necessary since partial pancreatectomy can prevent diabetes. In this prospectiv e study, pancreatic venous sampling (PVS) was evaluated for the preope rative localization of lesions in 25 children with hyperinsulinism and correlated with surgical, pathological and clinical outcome. PVS is t he most accurate preoperative technique for localizing focal lesions i n children. Besides being safe and effective, it has the great advanta ge of detecting focal secretion, thus reducing the need for extensive surgery.