National Institutes of Health Bethesda, Maryland 20892
To the editor:
We appreciate the comments of Drs.
Sumarac-Dumamovic, Mici, and Popovi
. We believe they
refer to two separate issues. First, the report of Service et
al. points out that the five patients they describe had
"exclusively postprandial hypoglycemia and negative fasts." Thus,
the two patients described in the above comment did not have this
syndrome. Our comment "that we have not seen islet hyperplasia or
nesidioblastosis that could be etiologically related to the patients
hypoglycemia" refers to sporadic case reports in adults that are
acknowledged to be very controversial in the discussion of the paper by
Service et al. For example, we have seen a patient who had a
distal pancreatectomy 10 yr ago with the pathologic findings of
hyperplasia and nesidioblastosis. Although the patient had transit
relief of symptoms, hypoglycemia continued and recently on reoperation
an insulinoma was enucleated from the remnant pancreas with
complete relief of hypoglycemia.
Thus, unfortunately neither our paper nor our experience clarifies the clinical significance of the histologic finding of hyperplasia and/or nesidioblastosis in adult pancreatic specimens.
Footnotes
g Received January 24, 2001. Address correspondence to: Phillip Gorden, M.D., NIDDK Director, National Institutes of Health, Building 10, Room 8S235, Bethesda, Maryland 20892.
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