Postprandial hypoglycemia in islet beta cell hyperplasia with adenomatosis of the pancreas

✍ Scribed by Dr. Joseph M. Tibaldi; Daniel Lorber; Steven Lomasky; J. J. Steinberg; Robert Reisman; Harry Shamoon

• Publisher: John Wiley and Sons
• Year: 1992
• Tongue: English
• Weight: 457 KB
• Volume: 50
• Category: Article
• ISSN: 0022-4790
• DOI: 10.1002/jso.2930500115

✦ Synopsis

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 P-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.