Introduction: Recently, noninsulinoma pancreatogenous hypoglycaemia syndrome (NIPHS) has been described following Roux-en-Y Gastric Bypass Surgery in morbidly obese patients. It has been proposed that hypoglycaemia might be a consequence of a failure to adaptively decrease insulin secretion after surgery. The authors present a case of a morbidly obese patient with severe hypoglycaemias beginning 3 months after gastric banding surgery.
Case report: A 60-year-old patient, with a long evolution history of morbid obesity (BMI 52.2 kg/m2) and HBP since the age of 28, was submitted to gastric banding in December/2006. He lost about 30 kg in the 6 months following. Three months after surgery, clinical and laboratory hypoglycaemias were detected, sometimes with sudden loss of consciousness. The fasting test was performed and blood test results revealed: glucose 34 mg/dl; insulin 19.8 uUI/ml; Cpeptide 1.53 ng/ml. An abdominal helicoidally CT scan showed a 1.9 cm tumour in the head of the pancreas and a 1.1 cm tumour in the neck of the pancreas. Selective intraarterial injection of calcium gluconate was performed; there was a significant increase in serum insulin concentration after injection in gastroduodenal and splenic arteries, but not after injection in mesenteric or hepatic arteries. After medical therapy with oral diazoxide, he was submitted to proximal pancreatectomy on 07/07/24. The postoperative course was complicated by pancreatic fistula, retroperitoneal abscess and transient hyperglycemias. Histopathology revealed an insulinoma with well-defined contours. Three months after surgery the patient is asymptomatic and euglycemic.
Conclusion: Hypoglycaemic state in morbidly obese patients following bariatric surgery may occur as a result of endogenous hyperinsulinism. In the presence of hypoglycaemia, it seems important to establish a differential diagnosis between insulinoma and NIPHS.
03 - 07 May 2008
European Society of Endocrinology