Hypoglycemia in Children: Clinical Experience of a Tertiary Care Center

Introduction:
Hypoglycemia, an important cause of morbidity in children, is a challenging condition to diagnose and treat due to its heterogeneity.

Aim:
To describe the diagnoses and clinical characteristics of children with hypoglycemia referred to our clinic.

Methods:
This retrospective, single center study included 155 children (86 males, 0-18 years) diagnosed with hypoglycemia in 1992-2018, and followed at a tertiary care center. Clinical and laboratory data were reviewed and compared among groups according to their etiologic diagnoses and age at referral.

Results:
The cohort was divided by clinical diagnosis into six groups: ketotic hypoglycemia (KH) (n=45, 29.0%); congenital hyperinsulinemic hypoglycemia (CHH) (n=33, 21.2%); transient HH (n=28, 18.7%); metabolic disorder (n=16. 10.3%); systemic disease/syndrome (n=15, 9.7%), and hormone deficiencies (n=10, 6.4%). At diagnosis 58 (37.4%) were neonates, 23 (14.8%) infants, 59 (38%) 1-6 years, and 15 (9.7%) 6-18 years. The most common diagnoses were: transient HH (48.3%) and CHH (32.7%) in neonates; CHH (34.8%) and KH (17.4%) in infants; KH (62.7%), metabolic disorders (11.8%) and CHH (10.1%) in children 1-6 years; and similar frequencies of KH, metabolic disorders, hormone deficiencies, and insulinoma in children >6 years. Comparisons of groups by diagnosis showed some statistically significant differences, with overlap between groups.

Conclusions:
Hypoglycemia etiology is heterogeneous and varies among neonates, infants, and children. Work-up should be directed for each age group based on clinical, biochemical, and imaging findings combined with next generation sequencing target panels.