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Nesidioblastosis in Adults: A Clinical Enigma^g

National Institutes of Health Bethesda, Maryland 20892

To the editor:

We appreciate the comments of Drs. Sumarac-Dumamovic, Mici, and Popovi. We believe they refer to two separate issues. First, the report of Service et al. points out that the five patients they describe had "exclusively postprandial hypoglycemia and negative fasts." Thus, the two patients described in the above comment did not have this syndrome. Our comment "that we have not seen islet hyperplasia or nesidioblastosis that could be etiologically related to the patients’ hypoglycemia" refers to sporadic case reports in adults that are acknowledged to be very controversial in the discussion of the paper by Service et al. For example, we have seen a patient who had a distal pancreatectomy 10 yr ago with the pathologic findings of hyperplasia and nesidioblastosis. Although the patient had transit relief of symptoms, hypoglycemia continued and recently on reoperation an insulinoma was enucleated from the remnant pancreas with complete relief of hypoglycemia.

Thus, unfortunately neither our paper nor our experience clarifies the clinical significance of the histologic finding of hyperplasia and/or nesidioblastosis in adult pancreatic specimens.

Footnotes

^g Received January 24, 2001. Address correspondence to: Phillip Gorden, M.D., NIDDK Director, National Institutes of Health, Building 10, Room 8S235, Bethesda, Maryland 20892.

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