Santore Lee Ann, Mandava Soumya, Lee Gloria, Chacko Mason
Renaissance School of Medicine, Stony Brook University Hospital, Stony Brook, New York, USA.
Department of Psychiatry and Behavioral Health, Stony Brook University Hospital, Stony Brook, New York, USA.
BJPsych Open. 2023 Oct 19;9(6):e198. doi: 10.1192/bjo.2023.506.
Nesidioblastosis is a rare condition of organic persistent hyperinsulinaemic hypoglycaemia, with fewer than 100 cases since it was first recorded. However, an increasing prevalence suggests previous underdiagnosis due to poor knowledge and awareness. This case describes the presentation, clinical decision-making and unique challenges in diagnosis and care of a 21-year-old female with nesidioblastosis and extensive psychiatric comorbidities. She was repeatedly misdiagnosed until 2021, despite having presented to emergency departments with hypoglycaemic symptoms for over 7 years. Her symptoms were often misattributed to behaviours secondary to restrictive anorexia nervosa and borderline personality disorder. Even after appropriate diagnosis and management, she suffered a complicated post-operative course. Patients with psychiatric comorbidities are at higher risk of distress, communication difficulties and inadequate social support, all of which could be better managed with increased multidisciplinary collaboration between endocrine, surgery, psychiatry, pain management and social work. This study highlights the importance of well-rounded patient care that addresses all facets of patient health. This approach not only improves quality of care, but also reduces overall readmissions, revisions, morbidity and mortality.
胰岛细胞增殖症是一种罕见的器质性持续性高胰岛素血症性低血糖症，自首次记录以来病例数不足100例。然而，其患病率不断上升，这表明由于认识不足和意识淡薄，以往存在漏诊情况。本病例描述了一名21岁患有胰岛细胞增殖症且伴有广泛精神疾病共病的女性患者的临床表现、临床决策以及诊断和护理中面临的独特挑战。尽管她因低血糖症状到急诊科就诊超过7年，但直到2021年她仍多次被误诊。她的症状常被误诊为继发于神经性厌食症和边缘型人格障碍的行为。即使经过适当的诊断和治疗，她术后的病程仍很复杂。患有精神疾病共病的患者面临更大的痛苦、沟通困难和社会支持不足的风险，通过内分泌、外科、精神病学、疼痛管理和社会工作之间加强多学科协作，可以更好地应对所有这些问题。本研究强调了全面关注患者健康各个方面的综合患者护理的重要性。这种方法不仅提高了护理质量，还减少了总体再入院率、翻修率、发病率和死亡率。
