title: Late Presentation of Fulminant Necrotizing Enterocolitis in a Child with Hyperinsulinism on Octreotide Therapy.
abstract: Congenital hyperinsulinism (HI) is the most common cause of persistent hypoglycemia in infants and children. In cases of diazoxide-unresponsive HI, alternative medical and surgical approaches may be required to reduce the risk of hypoglycemia. Octreotide, a somatostatin analog, often has a role in the management of these children, but a dose-dependent reduction in splanchnic blood flow is a recognized complication. Necrotizing enterocolitis (NEC) has been reported within the first few weeks of initiating predominantly high doses of octreotide. We describe the case of an infant with Beckwith-Wiedemann syndrome and diazoxide-unresponsive HI, who had persistent hypoglycemia after two pancreatectomy surgeries. She developed NEC 2 months after beginning octreotide therapy at a relatively low dose of 8 µg/kg/day. This complication has occurred later, and at a lower dose, than has previously been described. We review the case and identify the known and suspected multifactorial risk factors for NEC that may contribute to the development of this complication in patients with HI.
authors: Division of Endocrinology and Diabetes, The Children's Hospital of Philadelphia, Philadelphia, Pa., USA.
authors: Colin Patrick
authors: CP
authors: Hawkes
authors: N Scott
authors: NS
authors: Adzick
authors: Andrew A
authors: AA
authors: Palladino
authors: Diva D
authors: DD
authors: De León
mesh_terms: D001506:Beckwith-Wiedemann Syndrome / Q000188:drug therapy*; D044903:Congenital Hyperinsulinism / Q000188:drug therapy*; D020345:Enterocolitis, Necrotizing / Q000139:chemically induced* / Q000601:surgery; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D015282:Octreotide / Q000008:administration & dosage / Q000009:adverse effects*
chemical_list: D015282:Octreotide