Adult nesidioblastosis, diagnostic value of the selective arterial calcium stimulation test and perfusion computed tomography. A case report

Abstract

Endogenous hyperinsulinemia was found in a 38-year-old female patient with recurrent neuroglycopenic symptoms he glucose level was 25 mg/dL, insulin 43.9 mu/mL, C-peptide,54 ng/mL). No lesion was found on imaging tests including ahanced computed tomography (CT) methods performed ith a preliminary diagnosis of insulinoma. A suspicious yperperfusion was present in the pancreatic tail on the erfusion CT examination performed after obtaining approval. he selective arterial calcium stimulation test (SACST) result as consistent with a diffuse disease in the body and tail. The atient underwent partial (75%) pancreatectomy and is now)llowed up as a diabetes patient on intensive insulin treatment the postoperative 38th month.The most common cause of endogenous yperglycemia in hypoglycemia patients is insulinoma. The oninsulinoma pancreatogenous hypoglycemia syndrome NIPHS) is rarely seen in the adult age group. Although invasive, ACST seems to be the most suitable test to differentiate diffuse r multiple disease from insulinoma and to guide the surgery hen advanced radiological imaging methods are inadequate " detect the presence of insulinoma. Regarding perfusion CT, would be more appropriate to wait for comparative data to put forward in a more consistent manner. When no response an be obtained to medical treatment in NIPHS, partial/total ancreatectomy is the most appropriate treatment option as enables recovery from the hypoglycemic episodes despite ading to a significant condition like diabetes.