Posters
Presentation Type
Poster
Discipline Track
Translational Science
Abstract Type
Case Report
Abstract
Background: Nesidioblastosis is a term used to describe histologic changes in the pancreatic cell defined by beta cell hypertrophy and formation of ductoinsular complexes. It is a disease previously most extensively identified in neonates and is a rare cause of endogenous hypoglycemia in the adult population. However, with increasing numbers of gastric bypass surgeries for management of obesity in recent years, there has been a growing number of populations with post gastric bypass surgery related nesidioblastosis.
Case Description: Our case report follows a 60-year-old female with previous history of Roux-en-Y gastric bypass surgery who initially presented to an acute-care hospital with an episode of unprovoked seizure attributed to hypoglycemia and was later discharged to primary care for follow-up. In the primary care setting, patient described her hypoglycemic episodes to be postprandial specifically following carbohydrate containing meals. Further investigations with CT scan, upper gastrointestinal series, fasting insulin, and c-peptide levels showed normal results. A diagnosis of nesidioblastosis was considered after ruling out other causes of endogenous hypoglycemia. Patient was immediately started on continuous glucose monitoring which allowed patient to detect her blood glucose levels, thus regulate her meals, and conservatively manage her hypoglycemic episodes.
Conclusion: For patients with adult-onset nesidioblastosis post Roux-en-Y gastric bypass surgery presenting with mild to moderate hypoglycemia symptoms, better blood glucose control is achievable with conservative management in primary care setting. With increased access to continuous glucose monitoring, patients can identify hypoglycemia episodes early on and manage their symptoms and blood glucose levels with tailored dietary modification. For persistent symptoms, medical management is the next step in therapy followed by surgical management for severe or refractory symptoms.
Academic/Professional Position
Resident
Mentor/PI Department
Family Medicine
Recommended Citation
Manandhar, Karuna; Farahneh, Othman; and Munoz-Monaco, Gerardo, "Use of Translational Science, Continuous Glucose Monitoring in the Primary Care Setting for Management of Nesidioblastosis. A Case Report" (2024). Research Symposium. 27.
https://scholarworks.utrgv.edu/somrs/2023/posters/27
Included in
Use of Translational Science, Continuous Glucose Monitoring in the Primary Care Setting for Management of Nesidioblastosis. A Case Report
Background: Nesidioblastosis is a term used to describe histologic changes in the pancreatic cell defined by beta cell hypertrophy and formation of ductoinsular complexes. It is a disease previously most extensively identified in neonates and is a rare cause of endogenous hypoglycemia in the adult population. However, with increasing numbers of gastric bypass surgeries for management of obesity in recent years, there has been a growing number of populations with post gastric bypass surgery related nesidioblastosis.
Case Description: Our case report follows a 60-year-old female with previous history of Roux-en-Y gastric bypass surgery who initially presented to an acute-care hospital with an episode of unprovoked seizure attributed to hypoglycemia and was later discharged to primary care for follow-up. In the primary care setting, patient described her hypoglycemic episodes to be postprandial specifically following carbohydrate containing meals. Further investigations with CT scan, upper gastrointestinal series, fasting insulin, and c-peptide levels showed normal results. A diagnosis of nesidioblastosis was considered after ruling out other causes of endogenous hypoglycemia. Patient was immediately started on continuous glucose monitoring which allowed patient to detect her blood glucose levels, thus regulate her meals, and conservatively manage her hypoglycemic episodes.
Conclusion: For patients with adult-onset nesidioblastosis post Roux-en-Y gastric bypass surgery presenting with mild to moderate hypoglycemia symptoms, better blood glucose control is achievable with conservative management in primary care setting. With increased access to continuous glucose monitoring, patients can identify hypoglycemia episodes early on and manage their symptoms and blood glucose levels with tailored dietary modification. For persistent symptoms, medical management is the next step in therapy followed by surgical management for severe or refractory symptoms.