Hyperplazja wysp trzustkowych
(Hyperplasia of the isles of Langerhans)

Hyperplazja wysp trzustkowych
(Hyperplasia of the isles of Langerhans)
,
Slide nr.
175802_03F_HE_01
Hyperplazja wysp trzustkowych
(Hyperplasia of the isles of Langerhans)
,
Slide nr.
175802_03F_CHRA_01
Hyperplazja wysp trzustkowych
(Hyperplasia of the isles of Langerhans)
,
Slide nr.
175802_03H_HE_01
Hyperplazja wysp trzustkowych
(Hyperplasia of the isles of Langerhans)
,
Slide nr.
175802_03H_CHRA_03
Hyperplazja wysp trzustkowych
(Hyperplasia of the isles of Langerhans)
,
Slide nr.
175802_MIB1_02
See on virtual slides:
See large number of islets and concentrations of medium-sized islets on small integrally associated ductules (ductuloinsular complexes). Many of islet cells are not of the same or regular form and size, and have enlarged and hyperchromatic nuclei with nucleole and abundant clear cytoplasm. No mitotic figures are visible, and MIB1 staining is negative.
The case:
(Presented on 11th European Congress of Endocrinology, 25-29 April 2009, Istanbul, Turkey,
by Aldona Kowalska, Iwona Pałyga, Danuta Gąsior-Perczak, Jacek Sygut, Janusz Słuszniak & Stanisław Góźdź,
Holycross Cancer Center / Świętokrzyski Centrum Onkologii)

Introduction
Case reports of individuals with non-insulinoma hiperinsulinic hypoglicaemia of organic origin has been more frequently described in literature. This syndrome has been described as a rare complication of bariatric surgeries and the term of NIPHS (non-insulinoma pancreatogenic hypoglycemia syndrome) has been proposed.

Case description
A 45-year-old man who had previously undergone gastric surgery, was refered to our hospital for evaluation of hypoglycemia. At the beginning, the patient experienced only episodes of postprandial hypoglycemia and subsequently episodes of fasting hypoglycaemia appeared. Diagnostic imaging including ultrasound, CT, Octreoscan and EUS were negative for the patient. Post-operative changes and chronic pancreatitis impeded the interpretation of obtained results. Farmacological treatment with Proglicem or somatostatine analogues led only to transient improvement in control of hypoglycemic status.
Because pharmacological treatment was ineffective patient undergone partial pancreatectomy.
Finally the diagnosis of NIPHS has been established based on postoperative histological diagnosis established after partial pancreatectomy. See descriptions below the slides.

Conclusions
1. NIPHS must always be considered in differential diagnosis of adult patients with hypoglycaemia.
2. NIPHS may occur not only in patients after bariatric surgeries, but also after gastric surgeries caused by peptic ulcer.

Similar cases in literature:
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