Studies in Hypoglycemia of Infancy and Childhood

Abstract

ALTHOUGH elaborate classifications have been proposed, most children who develop hypoglycemia after the newborn period still fall into the group vaguely termed "idiopathic hypoglycemia of infancy and childhood." This study was undertaken to determine whether the clinical features and the responses to standard tests of blood sugar regulation are sufficiently distinctive to discriminate "idiopathic" cases from those of known etiology or provide any clues to possible etiologic mechanisms within the idiopathic group. This was done by analyzing the findings in a group of infants and children with idiopathic hypoglycemia and contrasting them with those in selected cases of hypoglycemia caused by hypopituitarism or insulinoma.A further objective of this study was to resolve some of the conflicting recommendations for the management of these patients. This report is based on the records of selected children admitted with the diagnosis of hypoglycemia to the North Carolina Memorial Hospital and Vanderbilt University Hospital. Much of these data were obtained under the ordinary pediatrie ward conditions of the two teaching hospitals. These retrospective analyses are reported together with the results of controlled therapeutic trials performed at the Clinical Research Unit of the North Carolina Memorial Hospital. Materials and Methods Clinical Data.-The charts of children admitted for hypoglycémie convulsions at North Carolina Memorial Hospital and Vanderbilt UniversityHospital were reviewed. Only those patients whose convulsions were proven on one or more occasions to be due to hypoglycemia at a time when no other illness was evident were included in the analysis. Patients were excluded if their hypoglycémie episodes were limited to the neo¬ natal period, or if, on further study, they were found to have glycogen storage disease, galac¬ tosemia, hypopituitarism, liver disease, episodic ketosis, or some other systemic illness. Other patients were not included because their data were insufficient to rule out these disorders or to contribute meaningful information. Thirteen infants and children met these criteria and were selected for analysis. Their findings were con¬ trasted with those of five other patients who were first admitted because of hypoglycémie seizures, but in whom the cause of the hypo¬ glycemia was eventually proven to be hypo¬ pituitarism or an insulinoma. The patients were grouped as follows: Group 1.-This group contained seven infants with hypoglycemia of undetermined cause with the onset of symptoms before 1 year of age. Group 2.-This group contained six children with hypoglycemia of undetermined cause with the onset of symptoms after 1 year of age. Group 3.-Three children with documented

Insulinoma in childhood.

“…We have reviewed the literature on this subject and found 34 published cases in children aged less than 15 years, not including our own case (Antony, Underwood, and Van Wyk, 1967;Bernheim et al, 1961a;Boley, Lin, and Schiffmann, 1960;Massachusetts General Hospital, 1962;Drash and Schultz, 1967;Garces, Drash, and Kenny, 1968;Geraud et al, 1966;Hartmann et al, 1960;Hurez et al, 1961;MacGillivray, Galloway, and Easton, 1958;McQuarrie, 1954;Rogers, 1960;Salinas et al, 1968;Sauls, 1968;Scholten and van der Vegt, 1960;Thomson and Welch, 1962;Watkins and Traylor, 1963).…”

“…However, many investigators (Antony et al, 1967;Cunningham, 1964;Di George and Chiowanich, 1962;Drash and Schultz, 1967;Erlich and Martin, 1967;Schotland, Kaplan, and Grumbach, 1967) have found the test less valuable in childhood. This is because similar results occur in children with hypoglycaemia from other causes, notably McQuarrie's idiopathic type, leucine-sensitivity, and islet cell hyperplasia.…”

“…Oral leucine (Antony et al, 1967;Di George and Auerbach, 1960;Garces et al, 1968;Marks and Rose, 1965) and intramuscular or intravenous glucagon (Garces et al, 1968;Marks ard Rose, 1965) may produce hypoglycaemia in 'children with insulinomas and this test may give diagnostic help.…”

Judson J. Van Wyk, M.D.: his life and legacy

“…[1]), he also made many contributions to clinical endocrinology during this time (e.g. [2][3][4]). His second period began when he set about to isolate Ôsulfation factorÕ [5], the circulating substance that Salmon and Daughaday [6] suggested mediated the growth promoting actions of growth hormone.…”