Adult-onset nesidioblastosis causing hypoglycemia: an important clinical entity and continuing treatment dilemma

Arch Surg. 2001 Jun;136(6):656-63. doi: 10.1001/archsurg.136.6.656.


Hypothesis: Nesidioblastosis is an important cause of adult hyperinsulinemic hypoglycemia, and control of this disorder can often be obtained with a 70% distal pancreatectomy.

Design: The records of all adult patients operated on for hypoglycemia between 1974 and 1999 were reviewed retrospectively. Patients with the pathologic diagnosis of nesidioblastosis were contacted for follow-up (1.5-21 years) and are presented. Patients' results were compared with those of 36 other individuals with this disorder who were previously reported in the literature.

Setting: The University of Chicago Medical Center (Chicago, Ill), a tertiary care facility.

Patients: A consecutive sample of all patients operated on for hypoglycemia.

Interventions: Seventy percent distal pancreatectomy for all patients with nesidioblastosis, and maintenance therapy with verapamil hydrochloride for 2 patients.

Main outcome measures: Achievement of normoglycemia with and without medication, development of insulin-dependent diabetes mellitus, pancreatic exocrine insufficiency, and need for reoperation.

Results: Of 32 adult patients who underwent surgical exploration for hyperinsulinemic hypoglycemia at our institution, 27 (84%) were found to have 1 or more insulinomas, and 5 (16%) were diagnosed with nesidioblastosis. Each patient with nesidioblastosis underwent a 70% distal pancreatectomy. Follow-up duration for the 5 patients ranged from 1.5 to 21 years, with 3 patients (60%) asymptomatic and taking no medications, and 2 patients (40%) experiencing some recurrences of hypoglycemia. The 2 patients with recurrences are now successfully treated with a calcium channel blocker, an approach, to our knowledge, never before reported for adult-onset nesidioblastosis.

Conclusions: Nesidioblastosis is an uncommon but clinically important cause of hypoglycemia in the adult population, and must always be considered in a patient with a presumptive preoperative diagnosis of insulinoma. This study indicates that a 70% distal pancreatectomy is often successful in controlling hypoglycemia, and rarely results in diabetes mellitus. However, the optimal treatment of this disorder remains to be determined.

Publication types

  • Case Reports
  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Adult
  • Age of Onset
  • Calcium Channel Blockers / therapeutic use
  • Combined Modality Therapy
  • Diabetes Mellitus, Type 1 / etiology
  • Exocrine Pancreatic Insufficiency / etiology
  • Female
  • Humans
  • Hyperinsulinism / blood
  • Hyperinsulinism / etiology*
  • Hypertrophy
  • Hypoglycemia / blood
  • Hypoglycemia / etiology*
  • Immunohistochemistry
  • Islets of Langerhans / pathology*
  • Male
  • Middle Aged
  • Pancreatectomy / adverse effects
  • Pancreatectomy / methods*
  • Pancreatic Diseases / complications*
  • Pancreatic Diseases / pathology
  • Pancreatic Diseases / surgery*
  • Recurrence
  • Retrospective Studies
  • Treatment Outcome
  • Verapamil / therapeutic use


  • Calcium Channel Blockers
  • Verapamil