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Hyperinsulinemic Hypoglycemia with Nesidioblastosis after Gastric-Bypass Surgery

Hyperinsulinemic Hypoglycemia with Nesidioblastosis after Gastric-Bypass Surgery,10.1056/NEJMoa043690,New England Journal of Medicine,Geoffrey J. Serv

Hyperinsulinemic Hypoglycemia with Nesidioblastosis after Gastric-Bypass Surgery   (Citations: 153)
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We describe six patients (five women and one man; median age, 47 years; range, 39 to 54) with postprandial symptoms of neuroglycopenia owing to endogenous hyperinsu- linemic hypoglycemia after Roux-en-Y gastric bypass surgery. Except for equivocal evi- dence in one patient, there was no radiologic evidence of insulinoma. Selective arterial calcium-stimulation tests, positive in each patient, were used to guide partial pancre- atectomy. Nesidioblastosis was identified in resected specimens from each patient, and multiple insulinomas were identified in one. Hypoglycemic symptoms diminished postoperatively. We speculate that hyperfunction of pancreatic islets did not lead to obesity but that beta-cell trophic factors may have increased as a result of gastric bypass. consequence of the obesity epidemic in the united states 1 is the increasing use of gastric bypass surgery for patients with severe, medical- ly complicated obesity. 2 Some patients who have undergone this procedure have postprandial symptoms that have been ascribed to rapid emptying of gastric con- tents. 3 This phenomenon, referred to as the dumping syndrome, is characterized by vasomotor symptoms of diaphoresis, weakness, dizziness, and flushing, but not neu- roglycopenia. 4 In the past five years, we have treated six patients in whom postprandial symptoms of neuroglycopenia developed as a result of endogenous hyperinsulinemic hypoglycemia after gastric bypass. Their clinical presentation typified that of the non- insulinoma pancreatogenous hypoglycemia syndrome (postprandial neuroglycopenic hyperinsulinemic hypoglycemia and pancreatic nesidioblastosis) 5,6 and is also seen in some patients with insulinoma. 7 We attempted to determine whether hyperfunction of pancreatic islets as a result of nesidioblastosis, which is characteristic of the noninsuli- noma pancreatogenous hypoglycemia syndrome, or insulinoma was the basis for the hypoglycemia and to determine the possible role of gastric bypass in the genesis of the abnormal islets. subjects From 2000 to 2004, six patients (five women and one man; median age, 47 years; range, 39 to 54) who had undergone Roux-en-Y gastric bypass for extreme obesity were referred for evaluation of repeated episodes of postprandial hypoglycemia associat- summary
Journal: New England Journal of Medicine - N ENGL J MED , vol. 353, no. 3, pp. 249-254, 2005
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