Abstract
1. In this paper, two cases of hyperinsulinism were discribed.
2. Disturbance of consciousness and abnormality of EEG showing slow wave and high voltage appeared frequently particularly in fasting state. The lowest blood sugar level examined in the first case was 29mg% and in the second 44mg%.
3. No hypofunction of anterior pituitary, thyroid gland, adrenal cortex and medulla, and no disturbance of liver function were observed in these cases. Increased insulin like activity of serum was observed in both cases by rat diaphragm method. From these findings both cases were clinically diagnosed as organic hyperinsulinism. Therefore, the surgical treatment for pancreas was performed in both cases.
4. In the first case, a capsulated tumor (3.2×3.4×2.2cm, 14, 29) was found in the tail of pancreas, and after removal of this tumor hypoglycemic attack disappeared. The tumor was islet cell adenoma and contained 421.4units of insulin (29.6u/g of this tumor). Five months after the removal, the glucose tolerance test showed diabetic curve.
In the second case, tumor was not found, but hypoglycemia was improved by partial resection of pancreas (three fifth of pancreas). Extractable insulin concentration of the resected pancreas of the second case was higher than that of the normal pancreas.
In addition, histologic examination of this tissue proved hyperplasia of islet cells. These findings might show the hyperfunction of islet cells in the second case.
5Urine catecholamine level elevated in both cases, but after surgery catecholamine level falled into within normal value in the first case. In addition, eosinopenia, unstable state of autonomic nervous system, and hyperglycemic effect of patient's serum in the adrenalectomized mice were all disappeared in the first case after the removal of the tumor.
6. Skin test with insulin, extracted from the islet cell adenoma of the first case, was negative in both cases. Precipitation test with the same insulin and insulin bindlng test with insulin I131 were negative in the first case. Moreover, skin test and precipitation test with the bovine regular insulin were negative in both cases. Antibody to human and bovine regular insulin was not proved in both cases.
