The clinical use of diazoxide in leucine-sensitive hypoglycemia

Pregnancy complicated by insulinoma. Case report

An insulinoma was excised during pregnancy. The tumor was located by radiography and severe hypoglycaemia made it necessary to administer diazoxide to the mother. The out come in the pregnancy was satisfactory. The rationale and risks of giving diazoxide in pregnancy are discussed.

[Leucine sensitive hypoglycemia. Follow-up studies under treatment with diazoxide (author's transl)]

Since 1969 leucine sensitive hypoglycemia has been diagnosed in 4 infants. Elevated serum insulin levels suggested hyperinsulinism; in 1 infant islet cell hyperplasia was demonstrated by morphological examination of pancreatic tissue. All cases were treated with diazoxide and have been followed under therapy for periods ranging from 4 months to 6 1/4 years. The upper limit of dosage was 15 mg/kg. The blood glucose values promptly became normal in 2 infants under this regimen. The development of these patients was normal. In the 2 other infants treatment was effective only after the additional restriction of daily protein intake to 2-2.5 g/kg. Severe cerebral damage occurred in one of these infants due to recurrent episodes of hypoglycemia, causing further development to be considerably restricted; the other one developed satisfactorily but with moderate mental retardation. Both children are suffering from cerebral convulsions. In all patients hypertrichosis was the only side effect.

Effects of fetal exposure to diazoxide in man

Four infants were born to women treated with oral diazoxide for the last 19 to 69 days of pregnancy. Maternal plasma levels of diazoxide in the 5 days before delivery were related to the intake of the drug and varied between 11 and 43 μg/ml. At delivery the umbilical plasma diazoxide level was lower than that in the mother and was 6·5 to 25 μg/ml. At the age of 24 hours the plasma diazoxide level in the infants had not altered appreciably. Diazoxide was present in the amniotic fluid and was excreted in the urine in the first week of life. Urinary diazoxide excretion was greatest on days 2 and 3 and had fallen to low or undetectable levels by days 6 and 7. No effect of diazoxide was noted on the blood pressure or blood sugar levels of the infants in the first 24 hours. The glucose tolerance of 2 of the infants was normal at 24 hours, but that of the other 2, whose mothers had diabetes, was impaired. Each of the infants developed alopecia and one had hypertrichosis lanuginosa. Abnormal hair growth was first noted at the age of 1 week and persisted when the infants were last seen at the ages of 5 months to 1 year. The bone age of 3 was normal at a chronological age of 5 to 7 months but the fourth, when aged 1 year, had retarded ossification in the wrist. No abnormalities were detected in blood counts, immunoglobulin levels, or ocular development.