A previously healthy 18 year old female has repeated admissions over a six week period to the emergency department because of seizures. She has no previous history of epilepsy and denies any drug use. Imaging and electroencephalogram do not indicate epilepsy. Blood sugar levels are low on two occasions, 1.3 mmol / L and 1.7mmól / L (4.0 - 6.0 mmol / L). After further investigations the suspicion of an insulin-producing tumor arises. Extensive research and imaging is conducted to look for tumor growth without any findings. Subsequently she was sent abroad for further evaluation with a 11C-5HTP-PET scan, selective angiography with celiacography and an intra-arterial calcium stimulation test. She was diagnosed with nesidioblastosis. Here we will discuss the presentation and work-up of the medical case and review this rare causative disease.

Figure 1. A week-long blood glucose measurement done before surgery. Each line represents one day and the dotted line represents the average blood glucose value. Normal blood sugar levels are within the blue zone and hypoglycemic levels are within the red zone. The patient's average blood glucose level was 4mmól / L and failed to elevate during/after meals. 

Figure 2. A week-long blood glucose measurement done before surgery. Each line represents one day and the dotted line represents the average blood glucose value. Normal blood sugar levels are within the blue zone and hypoglycemic levels are within the red zone. The patient's average blood glucose level was 4mmól / L and failed to elevate during/after meals.

 

Guðrún Mist Gunnarsdóttir¹, Arna Guðmundsdóttir¹, Per Hellman², Peter Stålberg²

¹Landspítali University Hospital of Iceland, ²Department of Surgical Sciences, University Hospital, Uppsala University, Sweden.