Summary: A 56-year-old male presented to hospital with vomiting and was admitted for management of suspected aspiration pneumonia. His medical history was significant for a diagnosis of cerebral palsy and intellectual disability and he had suffered regular generalised tonic-clonic seizures (GTCS) since birth, despite multimodal anticonvulsant treatment. During his admission, his capillary blood glucose was noted to be 1.6 mmol/L during a seizure. Subsequent investigations confirmed hyperinsulinaemic hypoglycaemia secondary to diffuse pancreatic nesidioblastosis. His seizure disorder completely resolved when management of nesidioblastosis achieved consistent normoglycaemia.

Learning points: All patients who suffer seizure should have a blood glucose measured. Unrecognised hypoglycaemia in a neonate or infant confers a high risk of subsequent neurological damage. Persistent hyperinsulinaemic hypoglycaemia (PHH) in adults is highly likely to be caused by insulinoma, but diffuse pancreatic hyperinsulinism, particularly after bariatric surgery, should also be considered. Medical therapy of endogenous hyperinsulinaemic hypoglycaemia is complex, requiring intensive monitoring.

Keywords: Paediatric endocrinology; hypoglycaemia; pancreatic disease.

摘要： 一名56岁男性因呕吐入院，疑似吸入性肺炎而接受治疗。他的既往病史显示患有脑瘫和智力障碍，并且自出生以来一直反复出现全身强直阵挛发作（GTCS），尽管接受了多种抗癫痫药物治疗。在住院期间，他的一次抽搐过程中，毛细血管血糖被记录为1.6 mmol/L。后续检查确认了由于弥漫性胰腺Nesidioblastosis引起的高胰岛素血症性低血糖。当对Nesidioblastosis的管理使得血糖水平稳定在正常范围内时，他的癫痫发作完全停止。

学习要点： 所有发生抽搐的患者都应测量血糖水平。新生儿或婴儿未被发现的低血糖会带来较高的后续神经损伤风险。成人持续性高胰岛素血症性低血糖（PHH）很可能是由胰岛细胞瘤引起的，但也应该考虑弥漫性的胰腺高胰岛素血症，尤其是在胃旁路手术后出现的情况。内源性高胰岛素血症性低血糖的药物治疗复杂，并需要密切监测。

关键词： 儿科内分泌学；低血糖；胰腺疾病。