Neonatal nesidioblastosis--diagnosis and preoperative management

Two infants were admitted for severe, intractable hypoglycemia. "Fasting" tests lasting 45 and 30 minutes respectively revealed hypoglycemia with inappropriately elevated levels of plasma insulin and plasma C-peptide. Subsequently, somatostatin was infused to test the individual sensitivity of the B-cells. Basal and glucose-induced insulin and C-peptide secretion were significantly reduced. Preoperative treatment with somatostatin was introduced, which controlled the hypoglycemia. In both patients, subtotal pancreatectomy was effective in restoring normal glucose homeostasis.