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Revista Venezolana de Endocrinología y Metabolismo
versión impresa ISSN 1690-3110
Resumen
DE JESUS, Jenny; FUNG, Liliana; GARCIA, Franklin y NUNEZ, Marina. Nesidioblastosis en adolescentes: A propósito de un caso. Rev. Venez. Endocrinol. Metab. [online]. 2015, vol.13, n.1, pp.48-53. ISSN 1690-3110.
Objectives: To describe a clinical case of nesidioblastosis in a teenage patient. Clinical case: This is a fourteen-year-old female teenage patient, with current illness starting on February/2013 characterized by headache of moderate intensity, concomitantly diaphoresis and dizziness. In March/2013 she presents generalized tonic-clonic movements, ocular retroversion with loss of consciousness (2 opportunities) and is referred to a medical center where they find a glycemia of 48 mg/dl and 40 mg/dl respectively, improving with glucose solution. Since complementary studies revealed fasting hypoglycemia: glycemia 40 mg/dl for insulin value 46.7 μUI/ml, the patient is hospitalized for a 72 hours fasting test, and at 10 hours from the start, a Whipple triad is evidenced, and blood tests confirmed hypoglycemia due to endogenous hyperinsulinism. Localization studies are performed with no evidence of a lesion. On 07/24/2013 an open laparotomy is carried out. Postoperatory biopsy reported: Langerhans islet cell hyperplasia. During late postoperative period, hypoglycemic symptoms reappear. It is suggested to complete surgery and pharmacological management with Verapamil at 40 mg every 8 hours is started, with a satisfactory response. Conclusion: Nesidioblastosis is a rare cause of hypoglycemia by endogenous hyperinsulinism in adults, with no case reports in teenagers. It is clinically indistinguishable from insulinoma and it is necessary to biochemically demonstrate hyperinsulinemic hypoglycemia with a 72 hour fasting test. Imaging studies dont provide specific data. Surgical treatment is first choice and pharmacological treatment is reserved mainly for high-risk surgical patients and recurrence.
Palabras clave : nesidioblastosis; hypoglycemia; hyperinsulinism; Whipple triad; pancreatectomy.