Insulinoma in childhood.

Hypoglycaemia is an important cause of cerebral damage in childhood. While much attention has recently been directed to its detection and treatment in the neonatal period, in later childhood the diagnosis is often delayed. There are many possible causes of hypoglycaemia in childhood, but in only a minority of cases is a precise diagnosis made, the majority being labelled 'idiopathic'. An insulin-secreting islet cell adenoma of the pancreas (insulinoma) is a rare cause of childhood hypoglycaemia; Drash and Schultz (1967) found fewer than 30 cases in their review. The case of a 12-year-old girl with an insulinoma is described in this paper. In an attempt to establish the incidence of the condition in the United Kingdom, the heads of undergraduate and postgraduate Paediatric Departments were asked if any cases of insulinoma had been encountered by them during the previous 10 years. 4 cases were reported to us and brief details of these patients are also presented. In the adult the incidence of insulinoma is higher and the diagnostic criteria more clearly defined than in childhood. Our experience and that of others (Drash and Schultz, 1967; Floyd et al., 1964) suggests that diagnostic procedures, such as the tolbutamide test, are frequently unhelpful in childhood. The diagnosis and treatment of the condition in childhood is discussed.