Anlauf et al listed histologic criteria for the diagnosis of diffuse nesidioblastosis in an adult with persistent hyperinsulemic hypoglycemia (PHH). The authors are from the University of Kiel, University Hospital Zurich, University of Dusseldorf and University of Mainz.


Patient selection: hypoglycemia with elevated serum or plasma insulin concentration


Major criteria (seen in all cases):

(1) exclusion of insulinoma

(2) absence of proliferative activity in endocrine cells (presumably in the pancreas)

(3) islets show a normal spatial distribution of the various islet cell types

(4) beta-cells have an abundant clear cytoplasm and an enlarged, hyperchromatic nucleus



• Exclusion of factitious insulin administration could be added to the first major criterion.


Minor criteria (seen in some but not all cases):

(1) macronucleoli within beta cells

(2) islets with a lobulated structure or irregular shape

(3) increased number of islets

(4) enlargement of islets


The authors estimate that diffuse nesidioblastosis is present in about 4% of patients with PHH.


To read more or access our algorithms and calculators, please log in or register.