Necrotizing enterocolitis following a single very low dose of octreotide in a patient with congenital hyperinsulinism - a case successfully managed with 18F-DOPA PET/CT-guided surgery

Sep 30, 2026

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Octreotide is considered a second-line treatment for congenital hyperinsulinism unresponsive to diazoxide, but necrotizing enterocolitis (NEC) can occur as a serious adverse effect in a dose-dependent manner. A female infant developed NEC after a single subcutaneous injection of octreotide (1.6 μg/kg) despite inadequate glycemic control on diazoxide. NEC required bowel decompression surgery. 18F-DOPA PET/CT localized a focal pancreatic lesion, enabling resection with preservation of nearly the entire normal pancreas. This case underscores the need for close monitoring even after very low octreotide exposure and highlights imaging-guided surgical planning.

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Clinical Pediatric Endocrinology Vol.35 / No.1 January 2026 pp 92–97 Case Report Necrotizing enterocolitis following a single very low dose of octreotide in a patient with congenital hyperinsulinism: a case successfully managed with 18F-DOPA PET/CT-guided surgery Takeshi Uehara1 , Haruki Mizutani1, 2 , Naomi Hatabu1 , Toshinaru Fukae1 , Nao Takizaki1 , Masako Izawa1 , Junko Hanakawa1 , Hidehito Usui3 , Norihiko Kitagawa3 , Michiya Masue4 , and Koji Muroya1 1Department of Endocrinology and Metabolism, Kanagawa Children’s Medical Center, Yokohama, Japan 2Department of Endocrinology and Metabolism, Aichi Children’s Health and Medical Center, Obu, Japan 3Department of Surgery, Kanagawa Children’s Medical Center, Yokohama, Japan 4Department of Pediatrics, Central Japan International Medical Center, Gifu, Japan Highlights ● Octreotide should be used cautiously in patients at risk for necrotizing enterocolitis (NEC) . ● Adverse octreotide effects are dose-dependent; careful monitoring is needed. ● 18F-DOPA PET/CT is essential to determine the optimal surgical approach. Abstract. Octreotide is considered a second-line treatment for congenital hyperinsulinism unresponsive to diazoxide. Necrotizing enterocolitis (NEC) is a serious adverse effect of octreotide, typically occurring in a dose-dependent manner. Here, we report a case of necrotizing enterocolitis following a single administration of a very low dose of octreotide. A female infant was admitted on day 3 of life with severe hypoglycemia. Laboratory findings revealed hyperinsulinemia and hypoketotic hypoglycemia, confirming a diagnosis of congenital hyperinsulinism. Despite diazoxide therapy, adequate glycemic control was not achieved. As a second-line intervention, a single subcutaneous injection of octreotide (1.6 μg/kg) was administered. Two days post-administration, the patient developed abdominal distension and significant vomiting. NEC was diagnosed, necessitating bowel decompression surgery. Subsequent 18F-DOPA positron emission tomography/computed tomography revealed a focal lesion extending from the pancreatic head to the body. The lesion was successfully resected with preservation of nearly the entire normal pancreas. This case highlights that even a very low dose of octreotide may precipitate necrotizing enterocolitis, warranting close monitoring. Lesion localization using 18F-DOPA positron emission tomography/computed tomography is critical in guiding surgical management of congenital hyperinsulinism. Key words: congenital hyperinsulinism, octreotide, necrotizing enterocolitis, 18F-DOPA positron emission tomography/computed tomography Received: February 16, 2025 Accepted: August 9, 2025 Advanced Epub: August 20, 2025 Corresponding author: Koji Muroya, M.D., Ph/D., Department of Endocrinology and Metabolism, Kanagawa Children’s Medical Center, Mutsukawa 2-138-4, Minami-ku, Yokohama 232-8555, Japan. [E-mail: kmuroya@kcmc.jp](E-mail: kmuroya@kcmc.jp) This is an open-access article distributed under the terms of the Creative Commons Attribution NonCommercial No Derivatives (by-nc-nd) License <[http://creativecommons.org/licenses/by-nc-nd/4.0/](http://creativecommons.org/licenses/by-nc-nd/4.0/)> . Copyright© 2026 by The Japanese Society for Pediatric Endocrinology Clin Pediatr Endocrinol 93 Introduction Congenital hyperinsulinism (CHI) is the most common cause of persistent hypoglycemia in neonates, characterized by recurrent episodes of non-ketotic hypoglycemia resulting from abnormal insulin secretion by pancreatic β-cells (1) . CHI can be classified into transient and persistent forms. According to an epidemiological study by Lapidus et al., the incidence of the persistent form is approximately 3.5 per 100,000 live births (2) . Oral diazoxide is the first-line treatment for hyperinsulinemic hypoglycemia. When hypoglycemia does not respond adequately to diazoxide, subcutaneous octreotide (OTT) is considered the next therapeut

FAQs

Why was octreotide used in this case?

Octreotide was used as a second-line intervention because diazoxide therapy did not achieve adequate glycemic control in congenital hyperinsulinism.

What happened after the low-dose octreotide administration?

Two days after receiving a single very low dose of octreotide, the patient developed abdominal distension and significant vomiting, leading to NEC diagnosis and bowel decompression surgery.

How was the surgical plan guided?

18F-DOPA PET/CT identified the focal pancreatic lesion and its extent, supporting curative surgical resection while preserving nearly all normal pancreatic tissue.

Sep 30, 2026

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