March 1994

Invited Commentary

Author Affiliations

Portland, Me

Arch Surg. 1994;129(3):268. doi:10.1001/archsurg.1994.01420270044010

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The lack of a precise definition of the pathologic features of the pancreas in nesidioblastosis associated with hypersecretion of polypeptides is a problem. Much of what has been described in the pancreata removed from infants with hyperinsulinemic hypoglycemia and attributed to nesidioblastosis is disputed. Nesidioblastosis in adults has also not been adequately explained.

The ability of pancreata to excessively secrete different polypeptides when they harbor no demonstrable tumors is not unexpected. This phenomenon has been described with islet cell tumors, and the authors have documented for the first time that the same phenomenon can occur with nesidioblastic tissue. The changes in the islet cells described in this article are similar to those documented by others. In spite of the controversy over the definition of nesidioblastosis and its relationship to endocrinopathies such as hyperinsulinism, treatment appears to be pancreatectomy. Why is pancreatectomy successful?

One explanation is that the pathologic pancreatic changes

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