Diabetologia

, Volume 26, Issue 4, pp 282–289 | Cite as

The basic structural lesion of persistent neonatal hypoglycaemia with hyperinsulinism: deficiency of pancreatic D cells or hyperactivity of B cells?

  • J. Rahier
  • K. Fält
  • H. Müntefering
  • K. Becker
  • W. Gepts
  • S. Falkmer
Originals

Summary

Pancreatic tissue obtained at subtotal pancreatectomy from 15 infants with persistent hypoglycaemia with hyperinsulinism, and autopsy specimens from 23 age-matched normoglycaemic controls, were studied with morphometric methods after immunocytochemical staining of the four main islet cell types (A, B, D and pancreatic polypeptide cells). In three cases, a focal lesion was detected by gross examination. Macroscopic or microscopic examination did not distinguish the 12 other cases from controls. As found previously, nesidioblastosis was not a specific feature of the pancreas in infantile hypoglycaemia, being observed in age-matched controls as well. In cases with hypoglycaemia the volume density of B cells was not significantly increased; that of the A cells was within normal range. The volume density of pancreatic polypeptide cells was markedly augmented and that of somatostatin cells was significantly decreased. The mean nuclear volume of the B cells was increased by 40% in cases with diffuse changes, but in cases with a focal lesion this increase was restricted to the abnormal area. This finding is of decisive importance for diagnosis and has therapeutic implications. The increase in B-cell nuclear size is thought to reflect an enhanced functional activity of these cells. On the other hand, the figures obtained for the volume density of B and D cells must be viewed with some reservation because degranulation may interfere with accurate detection of these cells.

Key words

Persistent hypoglycaemia nesidioblastosis islet cells islet adenoma immunocytochemistry 

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Copyright information

© Springer-Verlag 1984

Authors and Affiliations

  • J. Rahier
    • 1
  • K. Fält
    • 3
  • H. Müntefering
    • 4
  • K. Becker
    • 4
  • W. Gepts
    • 2
  • S. Falkmer
    • 3
  1. 1.Department of PathologyUniversity Hospital St. Luc, University of Louvain in BrusselsBelgium
  2. 2.Department of PathologyFree University of BrusselsBrusselsBelgium
  3. 3.Department of PathologyUniversity of Lund, Malmö General HospitalMalmöSweden
  4. 4.Department of Paediatric PathologyInstitute of Pathology, Johannes Gutenberg UniversityMainzFRG

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