Nesidioblastosis and Subsequent Diabetes Mellitus in a Dog with Hyperinsulinemic Hypoglycemia Treated with Partial Pancreatectomy.

A 6.5 yr old castrated male mixed-breed dog was presented for clinical signs associated with hypoglycemia. Hyperinsulinemic hypoglycemia was diagnosed as the cause of the persistent hypoglycemia. No obvious pancreatic mass was seen on abdominal computed tomography and exploratory laparotomy. A partial pancreatectomy was performed with the suspicion of an insulinoma-causing hyperinsulinemic hypoglycemia. Nesidioblastosis was diagnosed based clinical, biochemical, and histopathologic findings. There was beta cell hyperplasia and no evidence of neoplasia. The dog was euglycemic postoperatively after a partial pancreatectomy. Long-term follow-up after 2 yr revealed that the dog was diagnosed with diabetes mellitus.

Resolution of hyperinsulinemic hypoglycemia following partial pancreatectomy in a dog with nesidioblastosis.

CASE DESCRIPTION A 6-year-old castrated male Australian Shepherd was evaluated because of a recent onset of persistent hypoglycemia. CLINICAL FINDINGS Physical examination results were generally unremarkable. No abnormalities were detected on thoracic radiographs, and abdominal ultrasonography revealed no obvious pancreatic lesion. Hematologic analysis revealed hypoglycemia with a high serum insulin-to-glucose concentration ratio. TREATMENT AND OUTCOME Insulinoma was suspected; medical treatment with prednisone was initiated, and exploratory laparotomy was performed. No pancreatic lesions or masses were observed. Partial left pancreatectomy and hepatic and local lymph node biopsies were performed. Histologic examination revealed islet cell hypertrophy and hyperplasia, with no evidence of neoplasia. Results of a PCR assay of the pancreatic tissue for Bartonella infection were negative. Clinical, biochemical, and histopathologic findings were compatible with nesidioblastosis. The clinical signs, including hypoglycemia, resolved after surgery. On follow-up examination 8 months later, the dog was apparently healthy and results of a CBC and serum biochemical analysis, including blood glucose concentration, were within respective reference ranges. CLINICAL RELEVANCE To our knowledge, this is the first report of nesidioblastosis in a dog for which clinical signs and clinicopathologic abnormalities resolved after partial pancreatectomy. Although extremely rare, nesidioblastosis should be considered a differential diagnosis in dogs with signs suggestive of insulinoma.

Nesidioblastosis in a simmental calf.

A 2-day-old Simmental calf with arthrogryposis and astasia was subjected to necropsy examination. The calf was normoglycaemic and normoinsulinaemic. Microscopically, pancreatic tissue was hyperplastic with an irregular lobular arrangement of pancreatic islets. Newly-formed islet cells budded from intralobular or intercalated ducts (so-called ductulo-insular complexes) and there were prominent blood vessels with telangiectatic features surrounded by rows of cuboidal-columnar islet cells. The newly-formed islets expressed insulin antigen immunohistochemically. The lesion was diagnosed as nesidioblastosis, an uncommon abnormality previously associated with the double muscling trait in cattle.

Spontaneously occurring extra-islet endocrine cell proliferation in the pancreas of young Beagle dogs.

Pancreas of Beagle dogs deriving from 166 male and 166 female animals were examined microscopically and were found to show nesidioblastosis-like structural alteration in 29 dogs. The lesion was represented by endocrine and ductular epithelial cell proliferation. The incidence profile and the severity of the changes observed were closely associated with the age of the dogs, younger dogs being more often and more seriously affected than older dogs. No link with altered insulin function has been established as serum glucose levels were found to be within the normal range. The pathology of spontaneous extra-islet endocrine cell proliferation in the young Beagle dogs, described in this study, has some similarities to that of nesidioblastosis of human neonates and infants.