Insulin-like growth factor binding protein-1 levels in the diagnosis of hypoglycemia caused by hyperinsulinism

The diagnosis of hypoglycemia caused by hyperinsulinism may be difficult because insulin levels are not uniformly elevated at the time of hypoglycemia. Insulin-like growth factor binding protein-1 (IGFBP-1) is a 28 kd protein whose secretion is acutely inhibited by insulin. We hypothesized that seru...

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Bibliographic Details
Published in:The Journal of pediatrics 1997-08, Vol.131 (2), p.193-199
Main Authors: Levitt Katz, Lorraine E., Satin-Smith, Marta S., Collett-Solberg, Paulo, Thornton, Paul S., Baker, Lester, Stanley, Charles A., Cohen, Pinchas
Format: Article
Language:English
Subjects:
Adolescent
Biological and medical sciences
Biomarkers - blood
C-Peptide - blood
Child
Child, Preschool
Endocrine pancreas. Apud cells (diseases)
Endocrinopathies
Fasting - physiology
Fatty Acids - metabolism
Female
Glycogen Storage Disease Type I - blood
Glycogen Storage Disease Type I - complications
Glycogen Storage Disease Type I - diagnosis
Human Growth Hormone - deficiency
Humans
Hyperinsulinism - complications
Hyperinsulinism - congenital
Hyperinsulinism - diagnosis
Hypoglycemia - blood
Hypoglycemia - diagnosis
Hypoglycemia - etiology
Hypopituitarism - blood
Hypopituitarism - complications
Hypopituitarism - diagnosis
Infant
Infant, Newborn
Insulin - blood
Insulin - physiology
Insulin-Like Growth Factor Binding Protein 1 - blood
Insulin-Like Growth Factor Binding Protein 1 - metabolism
Ketosis - blood
Ketosis - diagnosis
Lipid Metabolism, Inborn Errors - blood
Lipid Metabolism, Inborn Errors - complications
Lipid Metabolism, Inborn Errors - diagnosis
Male
Medical sciences
Tumors. Hypoglycemia
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Summary:The diagnosis of hypoglycemia caused by hyperinsulinism may be difficult because insulin levels are not uniformly elevated at the time of hypoglycemia. Insulin-like growth factor binding protein-1 (IGFBP-1) is a 28 kd protein whose secretion is acutely inhibited by insulin. We hypothesized that serum levels of IGFBP-1 would be a useful marker of hyperinsulinism. We measured IGFBP-1 levels during the course of standardized fasting studies in hospitalized children; 36 patients became hypoglycemic during the fasting studies, and samples obtained at the point of hypoglycemia were analyzed. On the basis of the currently used diagnostic criteria, 13 children had hyperinsulinism, 16 had ketotic hypoglycemia or no disorder, 3 had hypopituitarism or isolated growth hormone deficiency, 2 had glycogen storage disease type I, and 2 had fatty acid oxidation disorders. In control subjects (children with ketotic hypoglycemia or no disorder), IGFBP-1 levels rose during fasting to a mean of 343.8 ± 71.3 ng/ml in the sample drawn at the time of hypoglycemia. Mean IGFBP-1 levels at hypoglycemia for the entire group with hyperinsulinism were 52.4 ± 11.5 ng/ml, significantly different from levels seen in control subjects (p < 0.0001). In children with moderately controlled hyperinsulinism (fasting tolerance >4 hours), mean IGFBP-1 levels at the time of hypoglycemia were 71.5 ± 16.9 ng/ml. IGFBP-1 levels in the children with poorly controlled hyperinsulinism (fasting tolerance
ISSN:0022-3476
1097-6833
DOI:10.1016/S0022-3476(97)70153-7