Nesidioblastosis, myelodysplastic syndrome and nodular diabetic glomerulosclerosis in an elderly nondiabetic woman: an autopsy report

Nesidioblastosis as the cause of hyperinsulinaemic hypoglycaemia in an adul t is rare. We report here an additional case of nesidioblastosis, which res ulted in fatal hyperinsulinaemic hypoglycaemia in a 72-year-old woman with an underlying myelodysplastic syndrome. The diagnosis of nesidioblastosis w as established only after post-mortem examination with a careful exclusion of minute insulinoma. To our surprise, the renal pathology disclosed typica l diabetic nodular glomerulosclerosis in the same patient who had no previo us history of diabetes mellitus (DM). Nesidioblastosis has been reported to cause 'reversal' of Type 1 DM and insulinoma causing 'reversal' of Type 2 disease. We therefore hypothesize that our patient might have had an undiag nosed DM in the past, which resulted in the typical diabetic nodular glomer ulosclerosis. The nesidioblastosis caused a 'reversal' of DM and even the u ltimate development of hyperinsulinaemic hypoglycaemia.