Endocrine Abstracts

Nesidioblastosis is a well recognized cause of persistent hyperinsulineamic hypoglycemia of infancy. Regardless of the pancreatectomy procedure used, hypoglycaemia may recur during long term follow up. We describe a challenging case of recurrent hypoglycaemic episodes in a young adult.

We describe a 33-year-old landscape gardening laborer with history of insulin treated diabetes diagnosed at the age of 3 weeks old following subtotal pancreatectomy for nesidioblastosis. He presented with hypoglycemia and required partial pancreatectomy when he was 5 days old followed by subtotal pancreatectomy when 3 weeks old for nesidioblastosis. He was referred by his GP with 6 months of worsening hypoglycemia in spite of making appropriate insulin and dietary adjustments. He had four-five episodes of severe hypoglycemia nee ding to go to emergency department over this 6 month period and had loss of hypoglycemic awareness. On initial screening he had detectable C-peptide 0.12 μg/l (NR 1.1–4.4), insulin levels <0.5 mIU/l (NR 2.6–24.9). MRI and CT scan of abdomen showed a possible small area of residual pancreatic tissue in the region of head of pancreas. Octreotide scan did not show any increased uptake in this area.

Imaging has failed to show anything that was felt to surgically treatable. Octreotide scan showed no significant uptake reducing the potential for other therapeutic options at this stage. He is now taking Creon and a basal bolus insulin regimen with Novorapid and Detemir. He is currently adjusting his insulin and making life style changes in order to reduce hypoglycemic episodes. His hypoglycaemia is continuing to improve and he has returned to work.

• Should we do anything else at this stage to address his unexplained hypoglycaemic episodes?

•How do we control his hypoglycaemia if this gets worse in the future?

Should total pancreatectomy be considered as an option to prevent disabling hypoglycaemia in future?