Endocrine Abstracts

JOINT3326

Objectives: Hypoglycaemia is a metabolic disorder which may be related to a heterogeneous group of disease in non-diabetic patients. The aim of the current study was to establish the frequency of hypoglycaemia observed in non-diabetic children aged 0-18 years, admitted to a tertiary paediatric endocrine center outside the intensive care or emergency unit and to analyze the associated clinical symptoms, underlying causes and treatment strategies.

Methods: We analyzed data for 2 years (2023-2024) from the clinical database of a tertiary paediatric endocrine center to identify all non-diabetic hypoglycaemic patients with blood glucose levels (BGLs) ≤3.9 mmol/l. The clinical notes of all enrolled patients were reviewed for demographic data, risk factors for hypoglycaemia, associated clinical symptoms including neurological symptoms and/or seizures during the hypoglycaemic episodes, registered developmental delay, relevant recorded morbidities or newly diagnosed conditions. We performed auxology and standard clinical examination of all participants. Blood glucose levels (BGLs), insulin and other hormones were measured and treatment with intravenous glucose administration and/or specific medications was evaluated. All patients with diabetes or prescribed diabetic medications were excluded from the analysis.

Results: We found 100 hypoglycaemic episodes among 3012 hospital admissions (3.32%). The mean age of the identified patients was 7.6±5.3 years (ranged 0-17.9 years), 56.0% were boys. The mean BGL during the registered episodes was 3.49±0.42 mmol/l (1.39-3.90 mmol/l) and the most commonly associated clinical symptoms were fatigue (15%), hypotony (14%), abdominal pain (6%), generalized seizures (3%) and vomiting (3%). Hypoglycaemia due to a newly diagnosed condition was recorded for 34.0% of children, while the other 66 patients had previously recorded disease which could explain the symptoms of low BGLs. Less than 1/3 of the participants had neurodevelopmental delay and 40% of these neurologically affected patients had been diagnosed with epilepsy or cerebral palsy. The most common morbidities associated with the development of hypoglycaemia were: fasting/starvation due to illness/anorexia (31.4%), genetic syndromes (16.2%), hypopituitarism with combined pituitary hormone or isolated growth hormone deficiency (14.1%) and congenital hyperinsulinism (12.1%). One-fifth of children needed glucose infusions to treat hypoglycaemia with none requiring glucagon administration. Almost 60% of the identified participants were commenced or continued on a specific therapy including rhGH (42.4%), long-acting somatostatin analog (13.6%), therapeutic diet/milk (11.9%) and diazoxide (8.5%).

Conclusion: Non-diabetic hypoglycaemia in paediatric patients is of a significant clinical importance and should be diagnosed and treated promptly.