Diazoxide-Associated Pulmonary Hypertension in Patient with Hyperinsulinemic Hypoglycemia

Background: Congenital hyperinsulinism (CHI) is the most common of persistent hypoglycemia in infancy characterized by inappropriate insulin secretion in the presence of hypoglycemia. Objective: This case report evaluates the effect of Diazoxide treatmentin inducing pulmonary hypertension in a patient with hyperinsulinemic hypoglycemia. Case findings: A full-term baby male, birth weight 4.3kg, was born at 41 weeks gestation by emergency caesarean section due to fetal distress born in Al-Dawadmi Hospital. He developed convulsions started postnatally loaded with phenobarbitone then shifted to AL-Yamammah hospital as lifesaving case to be admitted in Neonatal ICU. He was found to have hyperinsulinemic hypoglycemia and started on Diazoxide. The patient readmitted in Pediatric ICUat age of 2 month with hypoxic respiratory failure. After evidence of pulmonary hypertension by Echocardiography, Diazoxide was held at 2nd day of admission but he developed recurrent attacks of hypoglycemia required Octreotide with intermittent glucagon. After 14 days, Echocardiographic study repeated and showed findings of non-obstructive hypertrophic cardiomyopathy with good systolic function and no evidences of pulmonary hypertension (PH). Conclusions: Pulmonary hypertension may be developed during Diazoxide therapy. Pulmonaryhypertension was evaluated by echocardiography at regular intervals. This complicationresolved once diazoxide has been withdrawn.