SAT153 A Case Of Hypoglycemia-induced Chest Pain Secondary To Adult Nesidioblastosis: A Case Report

Disclosure: O.L. Medina Espitia: None. A. Quintero Altare: None. V.A. Clavijo: None. L.C. Martínez Delgado: None. The report of the present case in the medical literature is important in itself because of the infrequency of Nesidioblastosis. Additionally, it allows us to show unusual forms of presentation such as chest pain, and dynamic electrocardiographic changes in the ST segment with negative troponin, which coincide with episodes of hypoglycemia. At admission, the patient consulted the emergency department for a clinical presentation consisting of progressive retrosternal chest pain radiating to the left cervical region associated with dyspnea for medium exertion, palpitations, and dysautonomic symptoms, given by nausea. Due to episodes of chest pain, a coronary arteriography had been performed six months before admission without evidence of obstructive lesions. During hospitalization, episodes of hypoglycemia were observed. Remarkably, it was possible to document Dynamic ST changes in all EKG leads during episodes of hypoglycemia, as shown in Figure 1. Among the differential diagnoses, hypoglycemia secondary to adrenal or thyroid dysfunction was considered a first possibility, which was ruled out in the presence of normal paraclinical tests and medications that could generate hypoglycemia (negative sulfonylurea tests) were ruled out. A fasting test was performed with results showing endogenous hyperinsulinemic hyperinsulinemia with levels of insulin in 35.5 mg/dL, C-peptide 9.34 ng/dL and blood glucose 34 mm/dL. MRI of the abdomen without lesions. Due to a history of gastric bypass, endoscopic ultrasonography was not performed, therefore pancreatic calcium stimulation test was performed with evidence of a significant delta over the territory of the splenic artery. A distal pancreatectomy was obtained. Pathology report with findings suggestive of Nesidioblastosis (Figure 2.). There was a complete resolution of episodes of hypoglycemia and chest pain for two weeks. The recurrence of hypoglycemia episodes led to ambulatory treatment, with diazoxide with complete resolution of events. Presentation: Saturday, June 17, 2023