Investigating paediatric hypoglycaemia: Dynamic studies at a tertiary paediatric hospital

Abstract

Aim Paediatric hypoglycaemia often requires specific investigations to determine aetiology. Samples from the time of hypoglycaemia may not be available and a diagnostic fasting test may be required. Additionally, fasting studies can determine safe fasting intervals and prolonged oral glucose challenges can assess hypoglycaemia due to abnormal post‐prandial glucose handling. This audit reviewed the current utility and yield of fasting studies, prolonged oral glucose challenges and starch loads. Methods Retrospective audit of clinical record to determine purpose and outcome of tests performed at a Tertiary Paediatric Endocrine/Metabolic Testing Unit in Sydney, Australia, from 2013 to 2018 inclusive. Results One hundred and thirty‐eight children (aged 3 weeks–17 years) underwent 170 tests: 122 fasting studies, 20 five‐hour OGTTs, 22 uncooked corn starch loads and six modified waxy maize starch (Glycosade) loads. The majority were for diagnostic purposes (n = 113, 66%), with 57 (34%) to guide management in patients with known diagnoses. Following diagnostic studies, 35 (31%) patients received a pathological diagnosis, the most common of which (n = 19, 17%) was accelerated starvation. Hypoglycaemia developed in n = 15/113 (13%) during the diagnostic studies. Management studies helped determine length of safe fast, adjustment of medication or diet and document resolution of pathology. Conclusion Fasting studies remain a safe and effective method to assist with diagnoses, confirm or exclude pathological causes of childhood hypoglycaemia and to guide management of known diagnoses in the paediatric population.

Dynamic Methods for Childhood Hypoglycemia Phenotyping: A Narrative Review

“…More recently Graves et al. showed that 4/91 fasting challenges performed in children with suspected or documented hypoglycemia resulted in an etiological diagnosis (i.e., hepatic GSD, partial ACTH deficiency, panhypopituitarism, isolated central hypothyroidism) ( 31 ).…”