Diagnostic Considerations
Misdiagnosis of hypoglycemic seizure as epileptic seizure will result in inappropriate treatment with anticonvulsants and failure to treat with glucose. Consider associated endocrine abnormalities, such as multiple endocrine neoplasia type I.
In addition to these and the conditions listed in the differential diagnosis, other problems to be considered include the following:
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Transient hypoglycemia of the newborn
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Erythroblastosis fetalis
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Drug effect (eg, tocolytics, quinine)
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Withdrawal of parenteral nutrition or dextrose-containing intravenous (IV) fluid
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Exogenous insulin administration (eg, Munchausen syndrome, Munchausen syndrome by proxy)
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Ingestion of oral hypoglycemic agents
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Hyperinsulinism with hyperammonemia
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Hyperinsulinism-hyperammonemic syndrome
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Insulin-secreting adenoma
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Ketotic hypoglycemia
Differential Diagnoses
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Pancreatic specimen showing congenital hyperinsulinism (CHI) viewed at low power. Paler-staining cells are neuroendocrine (islet) cells, which should be arranged in discrete islands within acinar lobules. Acinar cells are exocrine cells that have denser-staining, dark eosinophilic cytoplasm. These acinar cells are arranged in acini. In CHI, more neuroendocrine cells are present, and they are arranged more diffusely throughout the lobules. Image courtesy of Phil Collins, MD.
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Pancreatic specimen showing diffuse congenital hyperinsulinism (CHI) viewed at medium power. Paler-staining cells are neuroendocrine (islet) cells, which should be arranged in discrete islands within acinar lobules. Acinar cells are exocrine cells that have denser-staining, dark eosinophilic cytoplasm. These acinar cells are arranged in acini. In CHI, more neuroendocrine cells are present, and they are arranged more diffusely throughout lobules. Image courtesy of Phil Collins, MD.
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Pancreatic specimen showing diffuse congenital hyperinsulinism (CHI) viewed at high power. Paler-staining cells are neuroendocrine (islet) cells, which should be arranged in discrete islands within acinar lobules. Acinar cells are exocrine cells that have denser-staining, dark eosinophilic cytoplasm. These acinar cells are arranged in acini. In CHI, more neuroendocrine cells are present, and they are arranged more diffusely throughout lobules. Image courtesy of Phil Collins, MD.
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Normal pancreas. There are fewer paler-staining neuroendocrine (islet) cells, and they are arranged in more discrete islands. Image courtesy of Tom Milligan, MD, Driscoll Children's Hospital, Corpus Christi, Tex.
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Combined positron emission tomography (PET)/computed tomography (CT) scan of focal lesion in head of pancreas of infant with congenital hyperinsulinism. Uptake of 18F-L-DOPA glows brightly in head of pancreas (center), pinpointing abnormal cells in focal hyperinsulinism. Large glowing areas lower in image are kidneys, where 18F-L-DOPA is excreted. Image courtesy of Charles Stanley, MD, Children's Hospital of Philadelphia.
