Background
Congenital central hypoventilation syndrome (CCHS) is a rare disorder of autonomic control. A hypoglycaemic seizure in a 4-year-old girl with CCHS led to a more detailed examination of glycaemic control in a cohort of children with CCHS. Methods We conducted an observational cohort study of
glucose homeostasis in seven children (3 months to 12 years) with genetically confirmed CCHS using a combination of continuous
glucose monitoring (CGM), fasting studies and oral
glucose tolerance test (OGTT). CGM was used to compare the effect of
diazoxide and dietary intervention in the index patient. Results Hypoglycaemia was not elicited by fasting in any of the patients. Increased postprandial glycaemic variability was evident in all patients using CGM, with seven of seven patients demonstrating initial postprandial hyperglycaemia (plasma-
glucose concentration >7.8 mmol/L), followed by asymptomatic hypoglycaemia (plasma-
glucose concentration ≤2.8 mmol/L) in two of seven patients that was also demonstrated on OGTT. Both
diazoxide and low Glycaemic Index (GI) dietary intervention reduced the proportion of CGM readings <4 mmol/L; however,
diazoxide also increased the proportion of readings in the hyperglycaemic range. Conclusions
Glucose variability associated with autonomic dysfunction may be unrecognised in CCHS, particularly in children with more severe phenotypes. This report highlights the occurrence of hyperglycaemia as well as hypoglycaemia in CCHS. Given the challenges of recognising hypoglycaemia based on clinical symptomatology, the use of CGM may facilitate its identification allowing appropriate management. The observed normoglycaemia during fasting combined with increased postprandial plasma blood
glucose level (BGL) variability is more consistent with
dumping syndrome than persistent
hyperinsulinism.
Dietary modifications therefore may be more effective than
diazoxide in managing hypoglycaemia.