Journal List > Korean Diabetes J > v.33(3) > 1002297

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Lee, Song, Kim, Chang, and Kim: Hypoglycemia due to Focal Nesidioblastosis in a Patient with Type 2 Diabetes Mellitus
Case Report
Korean Diabetes Journal

Korean Diabetes Journal 2009; 33(3): 251-256.

Published online: 30 June 2009

DOI: https://doi.org/10.4093/kdj.2009.33.3.251

Hypoglycemia due to Focal Nesidioblastosis in a Patient with Type 2 Diabetes Mellitus

Eun Jung Lee1, Kee-Ho Song1, Suk Kyeong Kim1, Seong-Hwan Chang2, Dong-Lim Kim1

1Department of Internal Medicine, Konkuk University School of Medicine, Seoul, Korea.

2Department of Surgery, Konkuk University School of Medicine, Seoul, Korea.

dlkim@kuh.ac.kr

Received 14 May 2009       Accepted 3 June 2009

Copyright © 2009 Korean Diabetes Association

Abstract

We report a 45-year-old man with type 2 diabetes who presented with recurrent hypoglycemia. Biochemical and imagingstudies did not show any mass-like lesion in the pancreas, so prednisolone and diazoxide were administered for the treatment of hypoglycemia. However, the hypoglycemia persisted during and after the medical treatment. A selective arterial calcium stimulation test was performed and revealed a suspicious lesion at the head of the pancreas. The patient underwent enucleation of the pancreas head lesion. The lesion was confirmed histologically to be focal nesidioblastosis and surgical resection was successfully performed. The patient showed no hypoglycemic symptoms postoperatively.

Keywords: Diabetes mellitus, Nesidioblastosis, Hypoglycemia

Figures and Tables

Fig. 1
Pancreas MRI showed no abnormal finding.
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Fig. 2
Celiac angiography showed no abnormal finding.
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Fig. 3
Pancreas pathology. A. A slight increase in endocrine cell aggregates with nuclear pleomorphism randomly distributed in the pancreas. (H&E, ×200). B. Most endocrine cells in enlarged cell aggregates are positive for insulin immunohistochemical stains. (×200).
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Table 1
Serum insulin, C-peptide and glucose levels on 100 g oral glucose tolerance test
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Table 2
Intraarterial calcium stimulation with venous sampling
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