Rare Cause of Organic Hypoglycaemia: Association of Nesidioblastosis, Focal Nesidiodysplasia and Multiple Pancreatic Micro-Adenomas

The etiological diagnosis of hypoglycemia in the non-diabetic patient is complex and includes a variety of diseases, including endogenous hyperinsulinism caused by functional β-cell disorders, the latter also known as nesidioblastosis or non-insulinoma pancreatogenic hypoglycemia syndrome (NIPHS). We report the case of a 62-year-old patient, not known to be diabetic, hypertensive on triple therapy, presenting with hypoglycemic episodes reaching 0.34 g/l for 2 years. Biological tests showed insulinemia at 676 pmol/l (norms 18-173pmol/l), C-peptide at 2980 pmol/l (norms 300-1400pmol/l). An octreoscan revealed a focus of radiotracer fixation in the head of the pancreas. The patient underwent 2 operations with persistent hypoglycemia; the combination of diasoxide 300mg/d and lanreotide 120mg/3 weeks led to the disappearance of hypoglycemia and a favorable outcome.