Surgical treatment of organic pancreatic hypoglycemia in the pediatric age.

From 1974 to 1980, 6 patients were operated upon for organic hyperinsulinism. 218 patients reported in the last 5 years are studied. Age at onset of symptoms is the most important factor. In infants the diagnosis is urgent. A severe mental retardation can result from waste of time in diagnosis and treatment. Simultaneous measurement of blood glucose and insulinemia during fasting and feeding periods is sufficient. Diffuse lesions are frequent, even associated with Islet cell adenoma. Surgery based upon local portal insulinemia must be adequately large and should avoid repeated pancreatectomy. In older children the diagnosis is easy. When a localised lesion is the pathologic feature, after a complete exposure of the gland, local excision is the technique of choice.