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April 1964

Tolbutamide Tolerance in Hypoglycemic Children

Author Affiliations

George C. Cunningham, Jr., MD, Bruce Lyon Memorial Research Laboratory, Children's Hospital of the East Bay, Grove and 51st St, Oakland Calif 94601.; Research fellow of The Medical Staff, Children's Hospital of the East Bay.

Am J Dis Child. 1964;107(4):417-423. doi:10.1001/archpedi.1964.02080060419015

Introduction  The diagnosis of an islet cell tumor in infants and children is challenging because this extremely rare condition can be definitively cured by surgery. Since 1958, Fajans 1-3 and others,4-5 have had remarkable success using the tolbutamide tolerance test (T.T.T.) for the detection of functioning islet cell adenomas in adults. As yet, there has been little application of this test to infants and children. In four children with idiopathic hypoglycemia Fajans 2,3 noted a return to normal fasting range between two and three hours. Klein 6 and co-workers reported results of intravenous tolbutamine on 12 healthy children in 1958. Grumbach and Kaplan 7 reported a normal response to 25 mg/kg tolbutamide in one child with leucine-sensitive hypoglycemia. Recently DiGeorge and Chiowanich 8 obtained normal responses from 15 healthy children and 11 patients with cystic fibrosis. Two infants with hypoglycemia studied by these workers gave responses suggesting adenoma on

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