Hypoglycemia in a diabetes nurse care coordinator

Area of Science:

• Endocrinology
• Gastroenterology
• Surgical Pathology

Background:

• Nesidioblastosis is a rare condition characterized by excessive insulin secretion from pancreatic islet cells.
• It typically presents in neonates but can occur in adults, often misdiagnosed.
• Hyperinsulinemic hypoglycemia can manifest with symptoms like confusion, seizures, and sweating.

Observation:

• A 26-year-old diabetes nurse coordinator presented with recurrent symptomatic fasting hypoglycemia.
• Initial suspicion fell on self-induced illness due to hyperinsulinemia and suppressed C-peptide.
• Species-specific radioimmunoassay confirmed endogenous human insulin secretion during hypoglycemic episodes.

Findings:

• The patient's condition was attributed to endogenous insulin hypersecretion.
• Surgical intervention was promptly performed.
• The final diagnosis was nesidioblastosis in an adult.

Implications:

• This case highlights the importance of considering rare endocrine disorders in adults presenting with unexplained hypoglycemia.
• Accurate diagnosis through specialized testing is crucial for appropriate management.
• Surgical resection can be curative for adult nesidioblastosis, improving patient outcomes.