Congenital Hyperinsulinism Care Profile

After a patient is referred to The Children’s Hospital of Philadelphia, she may fit one of four different types of care profiles.

Patient type A: HI patient with focal disease — cured

  • Fasting test
  • Drug withdrawal
  • Localization studies
  • Surgery
  • Recovery in Harriet and Ronald Lassin Newborn/Infant Intensive Care Unit (N/IICU) 7–14 days
  • Fasting test
  • Discharge

Anticipated discharge planning needs:

In nearly all these cases, the patient is cured and requires only one visit with the local pediatric endocrinologist, with routine well-child follow-up care by the local pediatrician.

Patient type B: HI patient requiring medical therapy postoperatively

  • Fasting test
  • Drug withdrawal
  • Localization studies
  • Surgery
  • Recovery in N/IICU (7–14 days)
  • Medical therapy (10–14 days)
  • Fasting test
  • Discharge

Anticipated discharge planning needs:

Patient will require ongoing medical treatment by the local pediatric endocrinologist, including at least one fasting test and three outpatient visits per year.

Patient type C: Patient requiring diagnostic evaluation for HI

  • Overnight blood sugar monitoring
  • Oral glucose tolerance test (case-dependent)
  • Oral protein tolerance test (case-dependent)
  • Fasting test

If diagnosis is established:

  • Medical therapy
  • Fasting test
  • Discharge

Anticipated discharge planning needs:

Patient will require ongoing medical treatment by the local pediatric endocrinologist, including periodic re-evaluation.

Patient type D: HI patient requiring follow-up evaluation

  • Overnight blood sugar monitoring
  • Oral glucose tolerance test (case-dependent)
  • Oral protein tolerance test (case-dependent)
  • Fasting test
  • Blood sugar monitoring and medication adjustments until stable

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