BACKGROUND Nesidioblastosis usually refers to a series of clinical manifestations caused by the proliferation ofβ-cells in pancreatic islets,and these clinical manifestations are hyperinsulinemia and persistent hypog...BACKGROUND Nesidioblastosis usually refers to a series of clinical manifestations caused by the proliferation ofβ-cells in pancreatic islets,and these clinical manifestations are hyperinsulinemia and persistent hypoglycemia.According to the size of the lesion,nesidioblastosis is divided into focal nesidioblastosis,diffuse nesidioblastosis and atypical nesidioblastosis,and its pathogenesis is still unclear.Nesidioblastosis is mainly seen in infants and rarely reported in adults,especially focal nesidioblastosis,which is difficult to distinguish from insulinoma.CASE SUMMARY We report a case of adult focalβ-cell nesidioblastosis in which the preoperative diagnosis was insulinoma.The patient was a 48-year-old male who suffered from repeated morning and fasting palpitations,sweating,and severe disturbance of consciousness for 5 years.His blood glucose was found to be as low as 1.79 mmol/L during an attack.However,abdominal computed tomography showed no abnormalities.Magnetic resonance imaging and endoscopic ultrasonography demonstrated a nodular mass in the head of the pancreas,combined with hyperinsulinemia and high serum C-peptide.The patient was diagnosed with insulinoma and underwent Beger surgery;however,the postoperative pathological results showed nesidioblastosis.CONCLUSION Although surgical resection is the preferred option for nesidioblastosis,some cases can be treated non-surgically.In order to increase clinicians’understanding of nesidioblastosis,it is necessary to review the pathogenesis,diagnosis and treatment of this disease.展开更多
Insulinoma is a pancreatic endocrine tumor lower in size than 20 mm in 80% of the cases and his treatment is chirurgical. However, in certain circumstances such as an occult location or circumstances of metastases, me...Insulinoma is a pancreatic endocrine tumor lower in size than 20 mm in 80% of the cases and his treatment is chirurgical. However, in certain circumstances such as an occult location or circumstances of metastases, medical treatment is called for. Observation: A 29 years old patient with no specific pathological antecedents has presented severe hypoglycemia mainly in the morning. A patient was in a generally good condition. The fasting test revealed an inappropriate secretion of insulin at a venous glycemia of 0.35 g/l;which was corroborated by Turner index and altered glucose insulin index that we calculated. Moreover, the 8 h cortisolemia was normal at 90.13 ng/l, the TSH was normal at 1.44 μui/l, anti-insulin antibodies were negative at 6.7 U/l;the search of hypoglycemic sulfonamides was negative. Morphologically, she had three pancreatic tomodensitometry these were normal. She also had echo-endoscopy which showed a normal pancreas. The surgical exploration with preoperative echo is advised only after surgeon’s assessment when the technical conditions are not put together. The diagnosis of the occult insulinoma or of nesidioblastosis was retained. The medical treatment was retained. Due to the unavailability of diazoxide in our pharmacies and the high cost of analogs of somatostatine, she was provided with prednisone 0.5 mg/kg/24h which was 40 mg/day after common agreement. The evolution was favorable. Conclusion: It should be noticed that medical treatment can be suggested if insulinoma is not localized. This observation proves that the localization of the insulinoma can be unsuccessful. It should also be noticed that our experience is the fourth described in literature, where hypoglycemia in insulinomas is controlled by prednisone.展开更多
文摘BACKGROUND Nesidioblastosis usually refers to a series of clinical manifestations caused by the proliferation ofβ-cells in pancreatic islets,and these clinical manifestations are hyperinsulinemia and persistent hypoglycemia.According to the size of the lesion,nesidioblastosis is divided into focal nesidioblastosis,diffuse nesidioblastosis and atypical nesidioblastosis,and its pathogenesis is still unclear.Nesidioblastosis is mainly seen in infants and rarely reported in adults,especially focal nesidioblastosis,which is difficult to distinguish from insulinoma.CASE SUMMARY We report a case of adult focalβ-cell nesidioblastosis in which the preoperative diagnosis was insulinoma.The patient was a 48-year-old male who suffered from repeated morning and fasting palpitations,sweating,and severe disturbance of consciousness for 5 years.His blood glucose was found to be as low as 1.79 mmol/L during an attack.However,abdominal computed tomography showed no abnormalities.Magnetic resonance imaging and endoscopic ultrasonography demonstrated a nodular mass in the head of the pancreas,combined with hyperinsulinemia and high serum C-peptide.The patient was diagnosed with insulinoma and underwent Beger surgery;however,the postoperative pathological results showed nesidioblastosis.CONCLUSION Although surgical resection is the preferred option for nesidioblastosis,some cases can be treated non-surgically.In order to increase clinicians’understanding of nesidioblastosis,it is necessary to review the pathogenesis,diagnosis and treatment of this disease.
文摘Insulinoma is a pancreatic endocrine tumor lower in size than 20 mm in 80% of the cases and his treatment is chirurgical. However, in certain circumstances such as an occult location or circumstances of metastases, medical treatment is called for. Observation: A 29 years old patient with no specific pathological antecedents has presented severe hypoglycemia mainly in the morning. A patient was in a generally good condition. The fasting test revealed an inappropriate secretion of insulin at a venous glycemia of 0.35 g/l;which was corroborated by Turner index and altered glucose insulin index that we calculated. Moreover, the 8 h cortisolemia was normal at 90.13 ng/l, the TSH was normal at 1.44 μui/l, anti-insulin antibodies were negative at 6.7 U/l;the search of hypoglycemic sulfonamides was negative. Morphologically, she had three pancreatic tomodensitometry these were normal. She also had echo-endoscopy which showed a normal pancreas. The surgical exploration with preoperative echo is advised only after surgeon’s assessment when the technical conditions are not put together. The diagnosis of the occult insulinoma or of nesidioblastosis was retained. The medical treatment was retained. Due to the unavailability of diazoxide in our pharmacies and the high cost of analogs of somatostatine, she was provided with prednisone 0.5 mg/kg/24h which was 40 mg/day after common agreement. The evolution was favorable. Conclusion: It should be noticed that medical treatment can be suggested if insulinoma is not localized. This observation proves that the localization of the insulinoma can be unsuccessful. It should also be noticed that our experience is the fourth described in literature, where hypoglycemia in insulinomas is controlled by prednisone.
