Recurrent hypoglycemia in a young female with nesidioblastosis: A case report and review of literature

Table 2 Key differences between Nesidioblastosis, insulinoma and dumping syndrome

Feature	Nesidioblastosis	Insulinoma	Dumping syndrome
Pathophysiology	Diffuse or focal β-cell hyperplasia with inappropriate insulin secretion	Insulin-secreting pancreatic neuroendocrine tumor	Rapid gastric emptying causing exaggerated insulin response
Typical age	Neonates	Adults	Any age after gastric or bariatric surgery
Common risk factors	Post-bariatric surgery, idiopathic	MEN1, sporadic	Gastric surgery (RYGB, sleeve gastrectomy, gastrectomy)
Timing of hypoglycemia	Fasting and/or postprandial	Predominantly fasting	Postprandial (1-3 hours after meals)
Relationship to meals	Variable	Often relieved by eating	Occurs after meals, especially high-carbohydrate meals
Insulin during hypoglycemia	Inappropriately elevated	Inappropriately elevated	Elevated postprandially only
C-peptide	Elevated	Elevated	Normal to mildly elevated
Selective arterial calcium stimulation test	Diffuse or regional insulin response	Focal insulin step-up	Negative
Histopathology	Diffuse or focal islet hyperplasia, β-cell hypertrophy	Well-circumscribed neuroendocrine tumor	Normal pancreatic histology
Treatment	Dietary modification, diazoxide, octreotide. Subtotal or total pancreatectomy in refractory cases	Surgical enucleation or resection	Dietary modification
Risk of recurrence	High (especially after partial resection)	Low after complete excision	Symptoms may persist but improve with diet
Postoperative diabetes risk	High	Low to moderate	None

RYGB: Roux-en-Y gastric bypass.