Cure of hypoglycemic hyperinsulinism by enucleation of a focal islet cell adenomatous hyperplasia.

During pancreatectomy for refractory neonatal hyperinsulinemic hypoglycemia, a well-delineated focal adenomatous hyperplasia was enucleated. Intraoperative glucose levels returned to normal and pancreatectomy was averted. Seven months later the child is euglycemic. This experience suggests that during surgery for neonatal refractory hypoglycemia, a focal lesion should be sought, and if found, enucleated, and blood glucose monitored. If the glucose rises to euglycemic levels or above, the child should be monitored clinically. If sustained elevation is not maintained, a search for an additional focal lesion or pancreatectomy should be performed. Saving the pancreas may prevent future development of diabetes mellitus.