Citation Information :
Khandelwal D, Garg M, Dutta D, Garg A. Nesidioblastosis–Nonlocalized Hyperinsulinemic Hypoglycemia: A Diagnosis Likely Missed. World J Endoc Surg 2019; 11 (3):91-93.
Endogenous hyperinsulinemic hypoglycemia (EHH) on investigation shows low blood glucose because of excessive endogenous insulin. Adult onset nesidioblastosis is an uncommon cause of EHH in adults and on microscopy shows diffuse proliferation of pancreatic islet cells which bud from ductal epithelium. We herein present a rare case of symptomatic adult onset EHH, the cause for which could not be localized on imaging. A 45-year male patient was admitted with recurrent severe hypoglycemia. Biochemical evaluation confirmed EHH (blood glucose 25 mg/dL; simultaneous serum insulin 56.65 μIU/mL; C-peptide 10.25 ng/mL). Thyroid, cortisol, and other hormone evaluation were normal. All possible preoperative imaging could not localize any abnormal focal lesion in the pancreas. Distal pancreatectomy resulted in complete resolution of hypoglycemia episodes. Histopathology confirmed the diagnosis of nesidioblastosis. Patient was asymptomatic even after 1-year follow-up. In adult patients with EHH with negative imaging studies, nesidioblastosis should be suspected. Symptomatic cases can be successfully treated by distal pancreatectomy with subsequent histopathology giving the final diagnosis.
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