Pathogenesis, clinical features, and diagnosis of persistent hyperinsulinemic hypoglycemia of infancy
Persistent hyperinsulinemic hypoglycemia of infancy (PHHI), also referred to as congenital hyperinsulinism, familial hyperinsulinemic hypoglycemia, and primary islet cell hypertrophy (nesidioblastosis), is the most common cause of persistent hypoglycemia in neonates and infants. PHHI is a genetic disorder with both familial and sporadic forms, characterized by dysregulation of insulin secretion. Early recognition, diagnosis, and treatment are necessary to prevent or minimize neurologic damage from recurrent or prolonged episodes of hypoglycemia.
PHHI is a clinically and genetically heterogeneous disorder [1-4]. The clinical manifestations range from life-threatening hypoglycemia presenting on the first day of life to only mildly symptomatic hypoglycemia in a child or adolescent that may be difficult to identify. The response to medical and surgical therapy also varies [1-3].
An overview of the pathology, genetics, clinical features, and diagnosis of PHHI will be presented here. The treatment and complications of PHHI and a review on islet cell tumors (insulinomas), which have similar clinical and biochemical features to PHHI, are discussed in more detail separately