Metabolic studies in a child with a pancreatic insulinoma
F. Ginsberg-Fellner and E. J. Rayfield
An 8-year-old boy with a convulsive disorder for 3 1/2 years remined
seizure free for 20 months while being treated with phenytoin
(diphenylhydantoin) sodium, and then he had a relapse. He first
demonstrated hypoglycemia when he fasted prior to being placed on a
ketogenic diet. An oral glucose tolerance test indicated fasting and
postglucose hypoglycemia and substantial hyperinsulinemia. Somatostatin
infusion resulted in a modest increase in plasma glucose levels and a
decrease in serum insulin concentrations. A discrete pancreatic mass was
demonstrated preoperatively by celiac angiography that on surgical
extirpation, proved to be a benign intrapancreatic insulinoma. Evaluation
for islet cell tumors is of importance in children with seizure disorders
unresponsive to anticonvulsant medication. Furthermore, somatostatin may be
useful preoperatively in maintaining normal blood glucose concentrations in
patients with islet cell adenomas.