Adult Nesidioblastosis in Chronic Kidney Disease
Context. Nesidioblastosis is a rare cause of hyperinsulinemic hypoglycemia in adults. The diagnosis is further complicated in patients with kidney failure, since impaired renal function can cause hypoglycemia by itself and diagnostic criteria for this clinical scenario have not been developed yet. C...
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| Format: | Article |
| Language: | English |
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Wiley
2019-01-01
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| Series: | Case Reports in Endocrinology |
| Online Access: | http://dx.doi.org/10.1155/2019/7640384 |
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| author | Eduardo Lozano-Melendez Mercedes Aguilar-Soto Luis Eugenio Graniel-Palafox Laura Elena Ceceña-Martínez Rafael Valdez-Ortiz Fabio Solis-Jimenez |
| author_facet | Eduardo Lozano-Melendez Mercedes Aguilar-Soto Luis Eugenio Graniel-Palafox Laura Elena Ceceña-Martínez Rafael Valdez-Ortiz Fabio Solis-Jimenez |
| author_sort | Eduardo Lozano-Melendez |
| collection | DOAJ |
| description | Context. Nesidioblastosis is a rare cause of hyperinsulinemic hypoglycemia in adults. The diagnosis is further complicated in patients with kidney failure, since impaired renal function can cause hypoglycemia by itself and diagnostic criteria for this clinical scenario have not been developed yet. Case Description. We present the case report of a 36-year-old patient with end stage chronic kidney disease who presented to the emergency department because of hypoglycemia. However, the patient’s hypoglycemia did not respond well to medical treatment; the diagnosis of hyperinsulinemic hypoglycemia was made due to the presence of inappropriately high levels of insulin, proinsulin, and C-peptide during an episode of hypoglycemia. Imaging studies were performed without any conclusive findings; so selective intra-arterial pancreatic stimulation with hepatic venous sampling (SACTS) was done. Based on the results of this study the patient was referred for subtotal pancreatectomy. Classic criteria for the diagnosis of insulinoma with SACTS required a 2-fold increase in insulin levels but newer criteria suggest thresholds that are useful in the differential diagnosis of insulinoma and nesidioblastosis. In our patient, the former criteria were positive; however, the new criteria were not compatible with insulinoma but with nesidioblastosis, which was the final histopathological diagnosis. Conclusion. This seems to be the first case report of a patient with end stage chronic kidney disease and nesidioblastosis, as well as the first case of hyperinsulinemic hypoglycemia in the context of kidney failure diagnosed by SACTS. We consider this method to be very useful in patients with renal impairment because peripancreatic insulin levels do not depend on the renal function. |
| format | Article |
| id | doaj-art-9b51ce0b52df487b9e74c5b370711dc7 |
| institution | OA Journals |
| issn | 2090-6501 2090-651X |
| language | English |
| publishDate | 2019-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | Case Reports in Endocrinology |
| spelling | doaj-art-9b51ce0b52df487b9e74c5b370711dc72025-08-20T02:20:26ZengWileyCase Reports in Endocrinology2090-65012090-651X2019-01-01201910.1155/2019/76403847640384Adult Nesidioblastosis in Chronic Kidney DiseaseEduardo Lozano-Melendez0Mercedes Aguilar-Soto1Luis Eugenio Graniel-Palafox2Laura Elena Ceceña-Martínez3Rafael Valdez-Ortiz4Fabio Solis-Jimenez5Faculty of Medicine and Nutrition of the Juarez University of the State of Durango, Durango, Durango, MexicoDepartment of Internal Medicine, ABC Medical Center, Mexico City, MexicoDepartment of Vascular and Interventional Radiology, General Hospital of Mexico ‘Dr. Eduardo Liceaga’, Mexico City, MexicoDepartment of Internal, General Hospital of Mexico ‘Dr. Eduardo Liceaga’, Mexico City, MexicoDepartment of Nephrology, General Hospital of Mexico ‘Dr. Eduardo Liceaga’, Mexico City, MexicoDepartment of Internal, General Hospital of Mexico ‘Dr. Eduardo Liceaga’, Mexico City, MexicoContext. Nesidioblastosis is a rare cause of hyperinsulinemic hypoglycemia in adults. The diagnosis is further complicated in patients with kidney failure, since impaired renal function can cause hypoglycemia by itself and diagnostic criteria for this clinical scenario have not been developed yet. Case Description. We present the case report of a 36-year-old patient with end stage chronic kidney disease who presented to the emergency department because of hypoglycemia. However, the patient’s hypoglycemia did not respond well to medical treatment; the diagnosis of hyperinsulinemic hypoglycemia was made due to the presence of inappropriately high levels of insulin, proinsulin, and C-peptide during an episode of hypoglycemia. Imaging studies were performed without any conclusive findings; so selective intra-arterial pancreatic stimulation with hepatic venous sampling (SACTS) was done. Based on the results of this study the patient was referred for subtotal pancreatectomy. Classic criteria for the diagnosis of insulinoma with SACTS required a 2-fold increase in insulin levels but newer criteria suggest thresholds that are useful in the differential diagnosis of insulinoma and nesidioblastosis. In our patient, the former criteria were positive; however, the new criteria were not compatible with insulinoma but with nesidioblastosis, which was the final histopathological diagnosis. Conclusion. This seems to be the first case report of a patient with end stage chronic kidney disease and nesidioblastosis, as well as the first case of hyperinsulinemic hypoglycemia in the context of kidney failure diagnosed by SACTS. We consider this method to be very useful in patients with renal impairment because peripancreatic insulin levels do not depend on the renal function.http://dx.doi.org/10.1155/2019/7640384 |
| spellingShingle | Eduardo Lozano-Melendez Mercedes Aguilar-Soto Luis Eugenio Graniel-Palafox Laura Elena Ceceña-Martínez Rafael Valdez-Ortiz Fabio Solis-Jimenez Adult Nesidioblastosis in Chronic Kidney Disease Case Reports in Endocrinology |
| title | Adult Nesidioblastosis in Chronic Kidney Disease |
| title_full | Adult Nesidioblastosis in Chronic Kidney Disease |
| title_fullStr | Adult Nesidioblastosis in Chronic Kidney Disease |
| title_full_unstemmed | Adult Nesidioblastosis in Chronic Kidney Disease |
| title_short | Adult Nesidioblastosis in Chronic Kidney Disease |
| title_sort | adult nesidioblastosis in chronic kidney disease |
| url | http://dx.doi.org/10.1155/2019/7640384 |
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