Castillo-López M G, Fernandez M F, Sforza N, Barbás N C, Pattin F, Mendez G, Ogresta F, Gondolesi I, Barros Schelotto P, Musso C, Gondolesi G E
Diabetes Metabolic department, Hospital Universitario Fundación Favaloro, Buenos Aires, Argentina.
General Surgery, Liver, Intestinal and Pancreas Transplant Services, Hospital Universitario Fundación Favaloro, Buenos Aires, Argentina.
Clin Diabetes Endocrinol. 2022 Mar 15;8(1):3. doi: 10.1186/s40842-022-00138-x.
Hyperinsulinemic hypoglycemia is the most common cause of severe and persistent hypoglycemia in neonates and children. It is a heterogeneous condition with dysregulated insulin secretion, which persists in the presence of low blood glucose levels.
We report a case of a 15 year-old male with hyperinsulinemic hypoglycemia, who underwent a subtotal pancreatectomy after inadequate response to medical therapy. Pathological examination was positive for nesidioblastosis (diffuse β-cell hyperplasia by H-E and immunohistochemical techniques). The patient's blood glucose levels normalized after surgery and he remains asymptomatic after 1 year of follow-up. The systematic review allowed us to identify 41 adolescents from a total of 205 cases reported in 22 manuscripts, from a total of 454 found in the original search done in PubMed and Lilacs.
Although very well reported in children, hyperinsulinemic hypoglycemia can occur in adolescents or young adults, as it happens in our reported case. These patients can be seen, treated and reported by pediatricians or adult teams either way due to the wide age range used to define adolescence. Most of them do not respond to medical treatment, and subtotal distal pancreatectomy has become the elected procedure with excellent long-term response in the vast majority.
高胰岛素血症性低血糖是新生儿和儿童严重持续性低血糖最常见的原因。它是一种胰岛素分泌失调的异质性疾病，在血糖水平低时仍持续存在。
我们报告一例15岁男性高胰岛素血症性低血糖患者，在药物治疗反应不佳后接受了胰腺次全切除术。病理检查显示胰岛母细胞增生症阳性（苏木精-伊红染色和免疫组化技术显示弥漫性β细胞增生）。患者术后血糖水平恢复正常，随访1年后仍无症状。系统评价使我们从22篇手稿中报告的205例病例中识别出41例青少年，这些病例来自在PubMed和Lilacs中最初检索到的总共454例。
尽管高胰岛素血症性低血糖在儿童中已有大量报道，但在青少年或年轻成人中也可能发生，如我们报告的病例所示。由于用于定义青春期的年龄范围很广，这些患者可以由儿科医生或成人团队诊治和报告。大多数患者对药物治疗无反应，远端胰腺次全切除术已成为绝大多数患者首选的手术方式，长期疗效良好。
