Most instances of persistent hypoglycemia beginning in the first two years of life are unexplained. This idiopathic hypoglycemia, though uncommon, carries a high risk of neurologic complications which may be lessened by early recognition and adequate management. The affected children are otherwise normal and usually undergo spontaneous remission of the hypoglycemia by 6 to 10 years of age. Unfortunately, no form of long-term treatment has been uniformly effective. Used alone, frequent feeding is helpful only in milder cases, but it is an important part of any management program. Most patients respond to corticotropin or hydrocortisone analogues, but such therapy is associated with impairment of growth and other cushingoid changes, as well as with the risk of a suppressed adrenal cortex. In some patients the condition is effectively managed with epinephrine analogues given orally (ephedrine) or by multiple daily injections (Sus-Phrine).
Subtotal pancreatectomy has cured about 50% of the hypoglycemic children
IDIOPATHIC HYPOGLYCEMIA OF INFANCY. JAMA. 1966;197(8):654. doi:10.1001/jama.1966.03110080094029