Nesidioblastosis in Pregnancy: Navigating the Diagnostic and Therapeutic Challenges of a Rare Condition

Nesidioblastosis, a non-neoplastic proliferation of the pancreatic islet cells of Langerhans, is a rare cause of endogenous hyperinsulinemic hypoglycemia. Although initially thought of as a congenital disease affecting pediatric patients, it is well known nowadays to affect adults as well. In addition, it is increasingly documented as a rare sequela of bariatric surgeries. Management options include medical and surgical therapies, with little known about the beneficial effects of both. Nesidioblastosis affecting pregnant patients is even rarer, with scarce literature known about the optimal treatment. Herein, we present a 22-year-old woman in the 20th week of gestation who experienced symptomatic episodes of severe life-threatening hypoglycemia. The management of this case required a multidisciplinary team approach to navigate the complexities of diagnosis and treatment. The complexity of this case was further heightened by the differential diagnosis, including conditions like insulinoma. The scarcity of literature on nesidioblastosis in pregnancy further complicated the case, underscoring the need for more research and case studies to guide clinical practice.