The Children's Hospital of Philadelphia
www.chop.edu
Unraveling the Mysteries of Hyperinsulinism - Outcomes: Diffuse Disease

Charles A. Stanley, MD: Those that have diffuse disease we can reduce the amount of pancreas by surgery, but we can't cure it completely.

N. Scott Adzick, MD: If there are abnormal findings consistent with diffuse disease on each of the three biopsies then a near total pancreatectomy is done, saving only a tiny nub in the pancreas between the duodenumand the common bile duct. This hopefully will help in the management of the disease in terms of prevention of brain threatening hypoglycemia, but it's really not a cure. Some babies do quite well and don't need much in the way of additional medical therapy, others can have recurrent hypoglycemia and need additional medical therapy and then there's a third group that develops insulin dependent diabetes.

Eduardo Ruchelli, MD: No matter how much the surgeon removes there's always a chance that the cells that remain will continue to produce too much insulin, or if the surgeon removes too much pancreas well there won't be enough cells left and these are the patients who will become actually diabetic. So in a way they are trading one disease for another.