[Diagnostic evaluation of persistent neonatal hypoglycemia using the fasting test: behavior of glucoregulatory hormones and intermediary metabolites (1)].
The effect of insulin induced hypoglycemia on glucoregulatory hormones and intermediary substrates was studied in four infants (three boys and one girl, ages 12-89 days) with persistent hyperinsulinism secondary to nesidioblastosis (two) or microadenoma of the pancreas (two). During the "fasting test" the following data expressed as mean basal plasma values +/- SEM vs. mean hypoglycemic values +/- SEM were obtained: insulin (57.3 +/- 17.9 vs. 27.5 +/- 10.6 microU/ml), C-peptide (4.9 +/- 1.1 vs. 3.5 +/- 0.9 ng/ml), free fatty acids (0.30 +/- 0.01 vs. 0.32 +/- 0.02 mmol/l), beta-hydroxybutyrate (less than 0.03 vs. 0.05 +/- 0.02 mmol/l), alanine (204.0 +/- 67.5 vs. 228.3 +/- 64.9 mumol/l), lactate (5.3 +/- 0.7 vs. 5.4 +/- 1.1 mg/dl), pyruvate (41.3 +/- 4.8 vs. 19.7 +/- 4.2 mg/dl). These data suggest "inappropriate" elevation of insulin and C-peptide levels, inhibition of lipolysis and lack of gluconeogenic substrates secondary to endogenous HI. An increase of cortisol (6.5 +/- 4.1 vs. 16.3 +/- 5.7 micrograms/dl), adrenaline (0.015 +/- 0.05 vs. 0.25 +/- 0.24 ng/ml) (3 out of 4) and noradrenaline (0.28 +/- 0.06 vs. 0.64 +/- 0.14 ng/ml) was noted, whereas only minute increase was found for glucagon (134.3 +/- 51.7 vs. 177.0 +/- 76.2 pg/ml) and HGH (5.7 +/- 1.1 vs. 7.1 +/- 1.1 ng/ml). Although some stimulation of neonatal glucoregulatory hormones was evident, this was not strong enough for counteracting endogenous HI.
Lischka
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A
Abteilung für Neonatologie, Universitäts-Kinderklinik Wien.
D007516:Adenoma, Islet Cell / Q000175:diagnosis; D001786:Blood Glucose / Q000378:metabolism*; D003937:Diagnosis, Differential; D005215:Fasting; D005230:Fatty Acids, Nonesterified / Q000097:blood; D005260:Female; D006728:Hormones / Q000097:blood; D006801:Humans; D006946:Hyperinsulinism / Q000175:diagnosis*; D007003:Hypoglycemia / Q000175:diagnosis*; D007223:Infant; D007231:Infant, Newborn; D007657:Ketone Bodies / Q000097:blood; D007773:Lactates / Q000097:blood; D019344:Lactic Acid; D008297:Male; D010182:Pancreatic Diseases / Q000175:diagnosis; D010190:Pancreatic Neoplasms / Q000175:diagnosis; D011773:Pyruvates / Q000097:blood; D019289:Pyruvic Acid
D001786:Blood Glucose; D005230:Fatty Acids, Nonesterified; D006728:Hormones; D007657:Ketone Bodies; D007773:Lactates; D011773:Pyruvates; D019344:Lactic Acid; D019289:Pyruvic Acid
Diagnostische Abklärung der persistierenden neonatalen Hypoglykämie mittels "Auslasstest": Verhalten von glukoregulatorischen Hormonen und intermediären Metaboliten (Teil 1).