Endocrine Abstracts

A 67-year-old man developed recurrent episodes of diaphoresis, presyncope, and syncope approximately three hours after meals, two years post two-stage oesophagectomy for ypT2N0 oesophageal adenocarcinoma. He had completed neoadjuvant chemoradiotherapy and adjuvant nivolumab. Syncope workup, including EEG and MRI brain, was unremarkable. Clinical suspicion of late dumping syndrome led to endocrine referral. Continuous glucose monitoring (CGM) confirmed postprandial hypoglycaemia despite a slow-release carbohydrate diet. A structured low glycaemic index (GI) diet was introduced; however, repeat CGM demonstrated persistent hypoglycaemic episodes, with up to ten events over two weeks and an average duration of 45 minutes. Acarbose 50 mg twice daily was commenced and was generally well tolerated apart from mild gastrointestinal side effects. On follow-up CGM, the number of hypoglycaemic episodes decreased to six, though the duration of hypoglycaemia remained unchanged. The patient reported partial symptomatic improvement but continued to experience occasional presyncopal symptoms. While acarbose may have contributed to a modest reduction in episode frequency, clinically significant hypoglycaemia persisted. Further therapeutic escalation, including octreotide, is under consideration. This case highlights the utility of CGM in confirming late dumping syndrome and objectively monitoring response to intervention.