Diffuse nesidioblastosis diagnosed on a Ga-68 DOTATATE positron emission tomography/computerized tomography
A 50-day-old pre-term female infant presented with persistent hyperinsulinemic hypoglycemia. The child was born at 35 weeks of gestation, with breathing difficulty since birth. She developed cyanosis on day 2 of life with seizures thereafter. On investigation the child was found to be hypoglycemia (blood glucose level = 16.8 mg/dl) and hyperinsulinemia with serum insulin levels of 149.70 IU/ml (n = 2.0 IU/ml). Screening for sepsis was negative. The child required intravenous glucose infusion up to 10 mg/kg/min and oral feeds fortified with glucose to maintain euglycemic state. Ga-68 DOTATATE positron emission tomography/computerized tomography (PET/CT) scan showed diffusely increased tracer uptake in the entire pancreas with no abnormal tracer uptake anywhere else in the body, suggestive of a diffuse variant of nesidioblastosis []. The child is currently on injection octreotide but not fit for definitive surgical management (near total pancreatectomy).