title: An unusual case of concurrent insulinoma and nesidioblastosis.
abstract: BACKGROUND
  Endogenous hyperinsulinaemic hypoglycaemia in adults is most commonly caused by an insulinoma. Adult nesidioblastosis is rarely reported. To the best of our knowledge the presence of both insulinoma and nesidioblastosis has not been reported before.
  
  
  METHODS
  We report a case of a 35-year-old female presenting with neuroglycaemic symptoms. A supervised 72-hour fast confirmed hypoglycaemia in the presence of hyperinsulinaemia. Thorough pre-operative biochemical and radiological investigations, including selective splenic, superior mesenteric and portal venous sampling inferred a tentative diagnosis of adult nesidioblastosis. However, a grossly elevated insulin level within the splenic vein on a second set of venous sampling produced a high index of suspicion for the presence of an insulinoma. At surgical exploration both an insulinoma and nesidioblastosis were identified and confirmed by histological examination.
  
  
  CONCLUSIONS
  We report an even rarer entity of concurrent insulinoma and nesidioblastosis.
authors.affiliation: Department of Hepatobiliary and Pancreatic Surgery, Leicester General Hospital, Leicester, United Kingdom. ebright@doctors.net.uk
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Bright
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Garcea
authors.forename: Seok L
authors.initials: SL
authors.lastname: Ong
authors.forename: Webster
authors.initials: W
authors.lastname: Madira
authors.forename: David P
authors.initials: DP
authors.lastname: Berry
authors.forename: Ashley R
authors.initials: AR
authors.lastname: Dennison