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Kubsad PS, Vani H, Sheshadri T, Palany R. Clinical Profile and Efficacy of Long-Acting Octreotide in Hyperinsulinemic Hypoglycaemia. Indian J Endocrinol Metab 2024; 28:289-294. [PMID: 39086574 PMCID: PMC11288510 DOI: 10.4103/ijem.ijem_483_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Revised: 03/26/2024] [Accepted: 05/09/2024] [Indexed: 08/02/2024] Open
Abstract
Introduction Hyperinsulinemic hypoglycaemia (HH) is characterised by unregulated insulin secretion, leading to persistent non-ketotic hypoglycaemia with a lack of alternate fuel that induces a severe risk for brain damage and neurodevelopmental abnormalities. Octreotide, a somatostatin analogue, has been effectively administered as subcutaneous injections or depot preparations in diazoxide-unresponsive HH. Methods Children and infants with HH receiving short-acting octreotide injections were included. Anthropometric values, hypoglycaemic episodes, HbA1C, and side effects were noted from the records and were followed up for 12 months. Informed written consent was obtained from the parents before administration of a single dose of LAR (long-acting octreotide). Based on home-based glucose monitoring (HBGM), the dosage of LAR was modified, and short-acting octreotide was eventually withdrawn. The patients shared the injection's cost for cost-effectiveness. HH affects the quality of life (QoL) if not diagnosed and controlled adequately. A QoL questionnaire was given before starting LAR and after 6 months of receiving LAR, and the changes were noted accordingly. Results Twenty-two patients were diagnosed with HH, of which 11 infants and children were included in the study. Mutations were identified in 7 (63.63%) children. Daily octreotide could be tapered and stopped with the addition of sirolimus in one patient with an increasing dose of LAR to maintain euglycaemia. The hypoglycaemic episodes decreased with increasing dose of LAR with a decrease in the severity. Eight (72.7%) patients showed an improved lifestyle on LAR quantified through a QoL questionnaire. Conclusion LAR was found effective in reducing hypoglycaemic episodes with no adverse effects. The patient's parent's satisfaction was higher. Given its high cost, this trial achieved cost-effectiveness by sharing a single sitting of LAR injection.
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Affiliation(s)
- Payal S Kubsad
- Department of Paedistrics(Paediatric Endocrinology), Yeneopya Medical College, Mangalore, Karnataka, India
| | - H.N Vani
- Department of Paediatrics and Paediatric Endocrinology, Indira Gandhi Institute of Child Health, Bangalore, Karnataka, India
| | - Tejasvi Sheshadri
- Department of Paediatric Endocrinology, Rainbow Children’s Hospital, Bangalore, Karnataka, India
| | - Raghupathy Palany
- Department of Paediatrics and Paediatric Endocrinology, Indira Gandhi Institute of Child Health, Bangalore, Karnataka, India
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De Los Santos-La Torre MA, Del Águila-Villar CM, Lu-de Lama LR, Nuñez-Almache O, Chávez-Tejada EM, Espinoza-Robles OA, Pinto-Ibárcena PM, Calagua-Quispe MR, Azabache-Tafur PM, Tucto-Manchego RM. Hyperinsulinism-hyperammonemia syndrome in two Peruvian children with refractory epilepsy. J Pediatr Endocrinol Metab 2023; 36:207-211. [PMID: 36476334 DOI: 10.1515/jpem-2022-0490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 11/21/2022] [Indexed: 12/12/2022]
Abstract
OBJECTIVES Congenital hyperinsulinism (HI) is a heterogeneous clinical disorder with great variability in its clinical phenotype, and to date, pathogenic variants in 23 genes have been recognized. Hyperinsulinism-hyperammonemia syndrome (HI/HA) is the second most frequent cause of this disease that shows an autosomal dominant pattern and is caused by an activating mutation of the GLUD1 gene, which responds favorably to the use of diazoxide. HI/HA syndrome presents with fasting hypoglycemia; postprandial hypoglycemia, especially in those with a high protein content (leucine); and persistent mild hyperammonemia. Neurological abnormalities, in the form of epilepsy or neurodevelopmental delay, are observed in a high percentage of patients; therefore, timely diagnosis is crucial for proper management. CASE PRESENTATION We report the clinical presentation of two Peruvian children that presented with epilepsy whose genetic analysis revealed a missense mutation in the GLUD1 gene, one within exon 11, at 22% mosaicism; and another within exon 7, as well as their response to diazoxide therapy. To the best of our knowledge, these are the first two cases of HI/HA syndrome reported in Peru. CONCLUSIONS HI/HA syndrome went unnoticed, because hypoglycemia was missed and were considered partially controlled epilepsies. A failure to recognize hypoglycemic seizures will delay diagnosis and adequate treatment, so a proper investigation could avoid irreversible neurological damage.
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Affiliation(s)
| | - Carlos Manuel Del Águila-Villar
- Department of Endocrinology and Metabolism of The Child's Health National Institute, Instituto Nacional de Salud del Niño, Lima, Peru.,Faculty Member of the Medical School, Universidad Nacional Federico Villareal, Lima, Peru
| | - Luis Rómulo Lu-de Lama
- Department of Endocrinology and Metabolism of The Child's Health National Institute, Instituto Nacional de Salud del Niño, Lima, Peru
| | - Oswaldo Nuñez-Almache
- Department of Endocrinology and Metabolism of The Child's Health National Institute, Instituto Nacional de Salud del Niño, Lima, Peru.,Faculty Member of the Medical School, Universidad Nacional Federico Villareal, Lima, Peru
| | - Eliana Manuela Chávez-Tejada
- Department of Endocrinology and Metabolism of The Child's Health National Institute, Instituto Nacional de Salud del Niño, Lima, Peru
| | - Oscar Antonio Espinoza-Robles
- Department of Endocrinology and Metabolism of The Child's Health National Institute, Instituto Nacional de Salud del Niño, Lima, Peru
| | - Paola Marianella Pinto-Ibárcena
- Department of Endocrinology and Metabolism of The Child's Health National Institute, Instituto Nacional de Salud del Niño, Lima, Peru
| | - Martha Rosario Calagua-Quispe
- Department of Endocrinology and Metabolism of The Child's Health National Institute, Instituto Nacional de Salud del Niño, Lima, Peru
| | - Pamela Miluska Azabache-Tafur
- Department of Endocrinology and Metabolism of The Child's Health National Institute, Instituto Nacional de Salud del Niño, Lima, Peru.,Pediatric endocrinology fellow, Universidad Nacional Federico Villareal, Lima, Peru
| | - Rosa María Tucto-Manchego
- Department of Endocrinology and Metabolism of The Child's Health National Institute, Instituto Nacional de Salud del Niño, Lima, Peru.,Pediatric endocrinology fellow, Universidad Nacional Federico Villareal, Lima, Peru
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