부산대학교 도서관

An 83-year-old woman was admitted to our hospital because of a consciousness disturbance caused by hypoglycemia. She had a history of distal pancreatectomy for the treatment of insulinoma at 57 years of age. A 72-hour fast test induced hypoglycemia and relatively high levels of both insulin and C-peptide; therefore, so-called hyperinsulinemic hypoglycemia and recurrence of insulinoma was suspected. However, no pancreatic tumors were detected on imaging examinations and the blood glucose response to octreotide was atypical. We re-evaluated the pathological findings of a previously resected pancreatic specimen. The main findings were hyperplasia of islet cells, without tumorous changes. These findings are identical to nesidioblastosis. We examined the responses of glucagon-like peptide-1 (GLP-1) and glucose-dependent insulinotropic peptide (GIP) in the plasma to an oral load of 75 g of glucose. Both the basal and peak levels of GLP-1 were higher than those previously reported. Treatment with diazoxide was effective in preventing hypoglycemia by reducing insulin secretion. Several cases of nesidioblastosis developing after gastrectomy have been reported. The current patient had no history of gastrectomy. Hypersecretion of GLP-1 played a certain role in the development of beta-cell hypertrophy in this case. It is expected that further mechanisms will be clarified in the future.