Postprandial hypoglycemia in islet beta cell hyperplasia with adenomatosis of the pancreas.
Organic hyperinsulinism causing hypoglycemia in adults is caused by insulinoma, islet hyperplasia, or a combination of adenomata and hyperplasia. We present a patient with long-standing symptoms of postprandial hypoglycemia occurring within 15 minutes of meals in the absence of fasting hypoglycemic symptoms. An intravenous glucagon stimulation test resulted in a rise of plasma insulin from 194 to 21,883 pmol/L at 7.5 minutes. Blood glucose simultaneously rose from 4.9 to 5.9 mmol/L. A glucose tolerance test revealed an exuberant insulin response. A euglycemic hyperinsulinemic clamp demonstrated incomplete suppression of plasma C-peptide. At surgery, three nodules were found and a 50-60% distal pancreatectomy was performed. The pancreas revealed a combination of multiple beta-cell islet adenomata and islet hyperplasia with no evidence of nesidioblastosis. The coexistence of islet adenomata with hyperplasia must be considered in the differential diagnosis of postprandial hypoglycemia.
Tibaldi
J M
JM
Department of Medicine, Booth Memorial Medical Center, Flushing, New York.
Lorber
D
D
Lomasky
S
S
Steinberg
J J
JJ
Reisman
R
R
Shamoon
H
H
D000236:Adenoma / Q000150:complications / Q000175:diagnosis* / Q000473:pathology; D000328:Adult; D004435:Eating; D006801:Humans; D006965:Hyperplasia; D007003:Hypoglycemia / Q000209:etiology*; D007515:Islets of Langerhans / Q000473:pathology*; D008297:Male; D010190:Pancreatic Neoplasms / Q000150:complications / Q000175:diagnosis* / Q000473:pathology