January - March 2015, Volume 11, Issue 1

Cander S, Gul Oz O, Yildirim-Eryilmaz N, Ugras N, Erturk E, Ersoy C

Adult Nesidioblastosis, Diagnostic Value of the Selective Arterial Calcium Stimulation Test and Perfusion Computed Tomography. A Case Report

Acta Endo (Buc) 2015, 11 (1): 85-92
doi: 10.4183/aeb.2015.85

Endogenous hyperinsulinemia was found in a 38-yearold female patient with recurrent neuroglycopenic symptoms (the glucose level was 25 mg/dL, insulin 43.9 μ/mL, C-peptide 5.54 ng/mL). No lesion was found on imaging tests including enhanced computed tomography (CT) methods performed with a preliminary diagnosis of insulinoma. A suspicious hyperperfusion was present in the pancreatic tail on the perfusion CT examination performed after obtaining approval. The selective arterial calcium stimulation test (SACST) result was consistent with a diffuse disease in the body and tail. The patient underwent partial (75%) pancreatectomy and is now followed up as a diabetes patient on intensive insulin treatment at the postoperative 38th month. The most common cause of endogenous hyperglycemia in hypoglycemia patients is insulinoma. The noninsulinoma pancreatogenous hypoglycemia syndrome (NIPHS) is rarely seen in the adult age group. Although invasive, SACST seems to be the most suitable test to differentiate diffuse or multiple disease from insulinoma and to guide the surgery when advanced radiological imaging methods are inadequate to detect the presence of insulinoma. Regarding perfusion CT, it would be more appropriate to wait for comparative data to be put forward in a more consistent manner. When no response can be obtained to medical treatment in NIPHS, partial/total pancreatectomy is the most appropriate treatment option as it enables recovery from the hypoglycemic episodes despite leading to a significant condition like diabetes.

Keywords: Noninsulinoma pancreatogenous hypoglycemia syndrome, insulinoma, selective arterial calcium stimulation test, perfusion computed tomography

Correspondence: Soner Cander MD, Sevket Yilmaz Training and Research Hospital, Clinics of Endocrinology and Metabolism, Bursa, Turkey, E-mail: drcander@gmail.com