Omar Sangueza, MD; John Wei, MD; Carlos M. Isales, MD
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Sangueza O, Wei J, Isales CM. Pancreatic Fibrosis with Islet Cell Pseudoneoplastic Proliferation as a Cause of Hypoglycemia. Ann Intern Med. 1997;127:1042-1043. doi: 10.7326/0003-4819-127-11-199712010-00029
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Published: Ann Intern Med. 1997;127(11):1042-1043.
TO THE EDITOR:
Islet cell tumors (insulinomas) or islet hypertrophy (nesidioblastosis) are well-described causes of fasting hypoglycemia. The older medical literature, however, also lists exocrine pancreatic involvement as a cause of hypoglycemia . In animal models, ligation of the pancreatic duct leads to atrophy of the exocrine pancreas with secondary hypertrophy of the endocrine portion of the pancreas (Herxheimer-Mansfield phenomenon) [1, 2]. In humans, this islet hypertrophic reaction to pancreatic fibrosis has been termed “pseudoneoplastic proliferation”  and can be seen in patients with pancreatic carcinoma, mucoviscidosis associated with cystic fibrosis , and chronic pancreatitis . We describe a patient with recurrent severe hypoglycemia related to pancreatic fibrosis and secondary islet cell hypertrophy.
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