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Complexities in the medical management of hypoglycaemia due to congenital hyperinsulinism
Author(s) -
Worth Christopher,
Yau Daphne,
Salomon Estebanez Maria,
O’Shea Elaine,
Cosgrove Karen,
Dunne Mark,
Banerjee Indraneel
Publication year - 2020
Publication title -
clinical endocrinology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.055
H-Index - 147
eISSN - 1365-2265
pISSN - 0300-0664
DOI - 10.1111/cen.14152
Subject(s) - tolerability , medicine , hyperinsulinism , congenital hyperinsulinism , intensive care medicine , pediatrics , disease , hypoglycemia , insulin , management strategy , adverse effect , insulin resistance , business administration , business
Congenital Hyperinsulinism (CHI) is a rare disease of hypoglycaemia but is the most common form of recurrent and severe hypoglycaemia causing brain injury and neurodisability in children. The management of CHI is complex due to the limited choice of medications, all with a limited therapeutic window, often lacking efficacy and associated with serious side effects. The therapeutic strategy in CHI is to recognize and treat hypoglycaemia promptly, thereby optimizing long‐term neurological outcomes; this should be achieved through individualized treatment plans that deliver glycaemic stability while minimizing side effects. Further, such a strategy should consider the likelihood of reduction in disease severity over time, with dose adjustments and medication withdrawal as indicated to optimize both safety and tolerability. The option for pancreatic surgery should also be considered in specific circumstances as appropriate for the patient's best long‐term interests.