Objective: Postprandial hyperinsulinaemic hypoglycaemia (PPHH) is a well-recognised complication following gastrointestinal surgery and has been less commonly identified idiopathically in paediatric patients. This study reviewed the characteristics, diagnosis, management and outcomes of paediatric idiopathic and surgical PPHH.
Design: Retrospective chart review of children (≤ 18-year-old) at a single tertiary paediatric hospital diagnosed with PPHH between 2003 and 2018.
Method: PPHH cases were identified from the Endocrinology unit database. Demographics, method of diagnosis, management and outcomes were evaluated. Diagnostic tests included standard/prolonged oral glucose tolerance test (OGTT/POGTT), mixed meal test (MMT) and feed test (FT). Demographic data were summarised using standard descriptive statistics. Continuous and discrete variables were analysed using unpaired t-tests. Statistical significance was defined as P value <0.05.
Results: 34 children, 18 idiopathic and 16 post-gastrointestinal surgery, were diagnosed and managed for PPHH. Idiopathic patients had significantly longer duration of symptoms prior to diagnosis (2.54 vs 0.18 years, p=0.0009). 18% of cases required repeat testing to confirm diagnosis. Feed change was the most common intervention, used in 88%. 79% of cases required management with corn-starch or other medications. Acarbose was the most common medication (n=20) and improved glycaemic control in 80%, followed by diazoxide (n= 10) which improved control in 50%. Patients were followed for an average of 4.0 years (±3.4). 18 (53%) had improved glycaemic control and nine (26%) had no hypoglycaemic episodes on treatment. Resolution occurred in 12% taking between 1.54-5.54 years.
Conclusion- This study is the first and largest to describe and compare paediatric surgical and idiopathic PPHH. PPHH diagnosis was often delayed, particularly in idiopathic PPHH, and repeated testing may be required. Acarbose and diazoxide can be considered as medical agents in those with refractory hypoglycaemia, although use was limited by side-effects. PPHH improved in most children, but resolution was uncommon in our population.