2024 Volume 67 Issue 4 Pages 181-188
We present the case of a 56-year-old man with type2 diabetes who experienced frequent episodes of hypoglycemia despite discontinuing antidiabetic medication while being admitted to our cardiology department for coronary artery stenting. The patient was diagnosed with hyperinsulinemic hypoglycemia based on the findings of various tests (fasting blood glucose 36 mg/dL, insulin level 64.3 μU/mL, CPR level 13.3 ng/mL), and further investigations were conducted. Abdominal ultrasonography, CT, and MRI did not reveal any pancreatic tumors. Owing to the difficulty of performing invasive tests immediately after coronary stent placement, the patient was treated with diazoxide. However, the hypoglycemic episodes persisted and increased with the increasing doses of diazoxide. A Selective Arterial Calcium Injection (SACI) test showed positive findings, thus leading to the patient's decision to undergo surgery. A pathological examination confirmed hyperplasia of the pancreatic islet cells corresponding to the positive SACI test site, thereby leading to a diagnosis of nesidioblastosis. While the occurrence of nesidioblastosis in a patient with type2 diabetes is rare, in cases where no evident pancreatic tumors are present, we should consider the possibility of nesidioblastosis and carefully select the optimal surgical and treatment approaches.
