Avatapalle Bindu, Padidela Raja, Randell Tabitha, Banerjee Indraneel
Department of Paediatric Endocrinology, Manchester Children's Hospital, University of Manchester, Manchester, UK.
BMJ Case Rep. 2012 Jul 30;2012:bcr2012006271. doi: 10.1136/bcr-2012-006271.
Congenital hyperinsulinism (CHI) is a rare disorder of hypoglycaemia in children due to excessive and dysregulated insulin secretion. Octreotide, a somatostatin analogue, is used in the treatment of hypoglycaemia in Diazoxide unresponsive CHI, but is associated with side effects such as gastrointestinal dysmotility and rarely, necrotising enterocolitis. It would be important to recognise rare but serious side effects from Octreotide therapy, particularly with long-term use. In this report, we have described drug-induced hepatitis with moderately high doses of Octreotide in a child with diffuse CHI. While serum alanine transaminase levels rose significantly with Octreotide therapy (maximum dose 30 μg/kg/day), hepatitis resolved following discontinuation of medical treatment. Liver enzymes should be monitored routinely in children with CHI using long-term Octreotide treatment, particularly with high doses. The presence of drug-induced hepatitis should prompt discontinuation of Octreotide treatment with likely subsequent resolution.
先天性高胰岛素血症（CHI）是一种儿童期罕见的低血糖症，病因是胰岛素分泌过多且失调。奥曲肽是一种生长抑素类似物，用于治疗对二氮嗪无反应的CHI患者的低血糖症，但会伴有胃肠道动力障碍等副作用，坏死性小肠结肠炎则较为罕见。认识到奥曲肽治疗罕见但严重的副作用很重要，尤其是长期使用时。在本报告中，我们描述了一名弥漫性CHI患儿使用中等高剂量奥曲肽后出现药物性肝炎的情况。使用奥曲肽治疗期间（最大剂量30μg/kg/天）血清丙氨酸转氨酶水平显著升高，但停药后肝炎症状得以缓解。对于接受长期奥曲肽治疗的CHI患儿，尤其是高剂量治疗时，应常规监测肝酶。药物性肝炎的出现应促使停用奥曲肽治疗，随后症状可能会缓解。
