Abstract
Infants with persistent hyperinsulinism (HI) provide an excellent opportunity for studying the effect of insulin induced hypoglycemia (H) on glucoregulatory hormones and substrates. A total of 4 patients, 3 boys and 1 girl, ages 12-39 days, were studied. Three were found to have nesidioblastosis, one had a microadenoma of the pancreas.
Impaired fine tuning of glucose control became evident during the “fasting test” (the following values are mean basal values±SEM vs mean hypoglycemic values±SEM): insulin (57.3±17.9 vs 27.5±10.6 μU/ml), C-peptide (4.9±1.1 vs 3.5±0.8 ng/ml), FFA (0.30±0.01 vs 0.32±0.02 mval/1), ß-hydroxybutyrate (< 0.03 vs < 0.03 mmol/l), acetoacetat (< 5 vs < 5 pmol/l), lactate (5.3±0.7 vs 5.4±1.1 mg/dl). These data suggest “inappropriate” high insulin and C-peptide levels, which inhibit lipolysis and gluconeogenesis.
An increase of plasma cortisol (6.5 ±7.1 vs 18.6±6.3 ng/ml), adrenaline (0.02±0.005 vs 0.25±0.24 ng/ml), noradrenaline (0.28±0.06 vs 0.68±0.14 ng/ml) was noted,whereas no or only minute increase was found for glucagon (134.3±89.6 vs 161.3±101.4 ng/ml) and hGH (5.7±1.8 vs 7.1±1.7 ng/ml). Although some stimulation of neonatal glucoregulatory hormones was evident, this was not strong enough for counteracting endogenous HI.
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Lischka, A., Pollak, A., Ogris, E. et al. EFFECTS OF FETAL AND NEONATAL HYPERINSULINISM ON GLUCOSE HOMEOSTASIS. Pediatr Res 19, 1087 (1985). https://doi.org/10.1203/00006450-198510000-00114
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DOI: https://doi.org/10.1203/00006450-198510000-00114
