Surgical treatment of hyperinsulinaemic hypoglycaemia in infancy and childhood.

Long-term treatment of persistent hyperinsulinaemic hypoglycaemia of infancy with diazoxide: a retrospective review of 77 cases and analysis of efficacy-predicting criteria

“…When medical treatment is ineective, most authors [20,25,28] recommend near-total pancreatectomy to avoid recurrent intractable hypoglycaemia and prevent brain damage. It is often a blind procedure with a high risk of persistent, albeit often attenuated, hypoglycaemia if inadequately complete, and a high risk of long-term complications like diabetes mellitus and pancreatic exocrine insuciency if excessive.…”

Persistent hyperinsulinaemic hypoglycaemia of infancy: therapy, clinical outcome and mutational analysis

“…The mainstay of medical treatment is oral diazoxide. If diazoxide fails in preventing hypoglycaemia, near total pancreatectomy is recommended [5,6].…”

Persistent hyperinsulinemic neonatal hypoglycemia caused by focal nesidioblastosis. Preoperative diagnosis by pancreatic venous sampling

“…Surgery is necessary for infants with hyperinsulinism who fail to be controlled by a conservative approach 1 . Currently, most pediatric surgeons recommend subtotal (95%) pancreatectomy at the time of initial surgery since lesser resections are unlikely to control BG levels 6 . Subtotal pancreatectomy, however, is an unphysiologic and essentially blind procedure and, although more effective than partial surgery, carries an almost 50% risk for later development of diabetes mellitus as well as exocrine pancreatic insufficiency 7 .…”