Hyperinsulin hypoglycemia in the neonate: therapeutic choices.

Lack of elevated serum insulin in 3 patients with nesidioblastosis following 95% pancreatectomy leaves one with the theoretical possibility that the recurrent hypoglycemia is not due to excess insulin secretion, but rather an iatrogenic hypoglucagon state. If this explanation is correct, progression to a "total" pancreatectomy may not be the appropriate form of therapy. It seems to us that further evaluation of other hormones secreted by the endocrine portion of the pancreas must be clarified before continuing extensive or total pancreatic resections for nesidioblastosis in infancy.