An unusual case of concurrent insulinoma and nesidioblastosis.
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.
Bright
Elizabeth
E
Department of Hepatobiliary and Pancreatic Surgery, Leicester General Hospital, Leicester, United Kingdom. ebright@doctors.net.uk
Garcea
Giuseppe
G
Ong
Seok L
SL
Madira
Webster
W
Berry
David P
DP
Dennison
Ashley R
AR