18 April 2025
: Case report 
Diagnostic and Surgical Management of Nesidioblastosis in a 42-Year-Old Man with Refractory Hypoglycemia
Challenging differential diagnosis, Unusual or unexpected effect of treatment, Rare disease, Educational Purpose (only if useful for a systematic review or synthesis)
Cleomar Ana de Souza Valentim
AEF 1, Vivien Suemi Arimura AEF 2, Isabella De Melo Pompei AEF 2, Denis Bonvechio BDF 3, Marcio Shimabuku Silva BDF 3, Fabio José Turrini BEF 3, Mariana Soares Dalla Mariga Jorgino AEF 4, Andre Silva Valentim ABCDEFG 4*
DOI: 10.12659/AJCR.945453
Am J Case Rep 2025; 26:e945453
Table 1. Biochemical and imaging tests.
| Test | Result | Reference range | |
|---|---|---|---|
| Insulin | 1.30 | 2.6–24.9 µIU/ml | |
| C-peptide | 0.90 | 1.1–4.4 ng/ml | |
| Pro-insulin | 4.99 | 0.7–4.30 pmol/l | |
| Insulin | 624.8 | 2.6–24.9 µIU/ml | |
| C-peptide | 0.30 | 1.1–4.4 ng/ml | |
| AB anti-insulin | 5.80 | <10 U/ml | |
| CT – computed tomography; PET – positron emission tomography; UVJ – ureterovesical junction; UPJ – ureteropelvic junction; AB – antibodies. | |||
| Imaging method | Result | ||
| Abdominal CT + kidneys and urinary tract | Ureteral microlithiasis - UVJ on the right, determining mild hydroureteronephrosis. Hepatic steatosis, nephrolithiasis on the left (Calculus in the UPJ 7 mm and calices in the upper pole 1,3cm), without obstructive appearance. Small umbilical hernia | ||
| No evidence of a well-differentiated neuroendocrine neoplasm detectable by the method, thus impairing confirmation of the hypothesis of insulinoma | |||
| Upper echo-endoscopy | Absence of pancreatic or peripancreatic lesions suspicious of insulinoma. Absence of lymph node enlargement in the chains studied | ||
| No evidence of detectable hypermetabolic foci under the present conditions | |||
| Pathological anatomy | Pancreatic parenchyma is within normal standards. Congestive splenomegaly. Note: Some islets of Langhans show slight hypercellularity. Clinical suspicion: Nesideoblastosis | ||
| CT – computed tomography; PET – positron emission tomography; UVJ – ureterovesical junction; UPJ – ureteropelvic junction; AB – antibodies. | |||