Organic hyperinsulinism and hypoglycemia due to coexistence of islet cell adenomatosis, nesidioblastosis, and hyperplasia in a patient with type 2 diabetes

Hypoglycemia due to organic hyperinsulinism in previously diabetic patients is very rare. In most of these cases, insulin producing adenomas are the c ause of the hyperinsulinism. We report, to our knowledge, the first case of hypoglycemia due to hyperinsulinism caused by the coexistence of islet cel l hyperplasia, nesidioblastosis and adenomatosis occurring in the setting o f type 2 diabetes. These histologic findings are included in the spectrum o f the so-called beta cell dysmaturation syndrome. We speculate on the possi ble pathophysiological interactions between these two seemingly opposite di sorders.