• Vol. 29 No. 5, 682–687
  • 15 September 2000

Hypoglycaemia from Islet Cell Hyperplasia and Nesidioblastosis in a Patient with Type 2 Diabetes Mellitus—A Case Report

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ABSTRACT

Introduction: We report the first case of hypoglycaemia from beta cell hyperplasia with nesidioblastosis in an Asian adult with pre-existing type 2 diabetes.

Clinical Picture: A 57-year-old Chinese woman presented with hyperinsulinaemic hypoglycaemia despite discontinuation of oral hypoglycaemic agents 4 months after diagnosis of type 2 diabetes. Preoperative portal venous sampling suggested regionalisation to the neck of the pancreas. Intraoperative ultrasound and palpation of the fully mobilised pancreas were non-localising.

Treatment: A subtotal 85% pancreatectomy was performed with success.

Outcome: Histology showed no evidence of tumour, but revealed islet hyperplasia and nesidioblastosis. Her diabetes was subsequently well controlled on metformin therapy.

Conclusion: Endogenous hyperinsulinism from beta cell hyperplasia with nesidioblastosis may rarely occur in type 2 diabetics. However, this remains a diagnosis of exclusion that is confirmed only on surgical pathology. In affected individuals, preoperative portal venous sampling may be falsely localising, especially if selective sampling of the smaller peri-pancreatic veins is omitted. Definite treatment involves pancreatectomy, although the extent of surgical resection is not well established.


A 57-year-old woman was admitted to our hospital for perforated left tubo-ovarian abscess and found to have newly diagnosed diabetes with an admission blood glucose of 23 mM and glycated haemoglobin value of 12% (reference range 4.6% to 6.4%). She denied past symptoms of thirst, polyuria or polydipsia.

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