Severe hypoglycaemia post-gastric bypass requiring partial pancreatectomy: evidence for inappropriate insulin secretion and pancreatic islet hyperplasia
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Severe hypoglycaemia post-gastric bypass requiring partial pancreatectomy : evidence for inappropriate insulin secretion and pancreatic islet hyperplasia. / Patti, M E; McMahon, G; Mun, E C; Bitton, A; Holst, Jens Juul; Goldsmith, J; Hanto, D W; Callery, M; Arky, R; Nose, V; Bonner-Weir, S; Goldfine, A B.
In: Diabetologia, Vol. 48, No. 11, 11.2005, p. 2236-40.Research output: Contribution to journal › Journal article › Research › peer-review
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TY - JOUR
T1 - Severe hypoglycaemia post-gastric bypass requiring partial pancreatectomy
T2 - evidence for inappropriate insulin secretion and pancreatic islet hyperplasia
AU - Patti, M E
AU - McMahon, G
AU - Mun, E C
AU - Bitton, A
AU - Holst, Jens Juul
AU - Goldsmith, J
AU - Hanto, D W
AU - Callery, M
AU - Arky, R
AU - Nose, V
AU - Bonner-Weir, S
AU - Goldfine, A B
PY - 2005/11
Y1 - 2005/11
N2 - AIMS/HYPOTHESIS: Postprandial hypoglycaemia following gastric bypass for obesity is considered a late manifestation of the dumping syndrome and can usually be managed with dietary modification. We investigated three patients with severe postprandial hypoglycaemia and hyperinsulinaemia unresponsive to diet, octreotide and diazoxide with the aim of elucidating the pathological mechanisms involved.METHODS: Glucose, insulin, and C-peptide were measured in the fasting and postprandial state, and insulin secretion was assessed following selective intra-arterial calcium injection. Pancreas histopathology was assessed in all three patients.RESULTS: All three patients had evidence of severe postprandial hyperinsulinaemia and hypoglycaemia. In one patient, reversal of gastric bypass was ineffective in reversing hypoglycaemia. All three patients ultimately required partial pancreatectomy for control of neuroglycopenia; pancreas pathology of all patients revealed diffuse islet hyperplasia and expansion of beta cell mass.CONCLUSIONS/INTERPRETATION: These findings suggest that gastric bypass-induced weight loss may unmask an underlying beta cell defect or contribute to pathological islet hyperplasia, perhaps via glucagon-like peptide 1-mediated pathways.
AB - AIMS/HYPOTHESIS: Postprandial hypoglycaemia following gastric bypass for obesity is considered a late manifestation of the dumping syndrome and can usually be managed with dietary modification. We investigated three patients with severe postprandial hypoglycaemia and hyperinsulinaemia unresponsive to diet, octreotide and diazoxide with the aim of elucidating the pathological mechanisms involved.METHODS: Glucose, insulin, and C-peptide were measured in the fasting and postprandial state, and insulin secretion was assessed following selective intra-arterial calcium injection. Pancreas histopathology was assessed in all three patients.RESULTS: All three patients had evidence of severe postprandial hyperinsulinaemia and hypoglycaemia. In one patient, reversal of gastric bypass was ineffective in reversing hypoglycaemia. All three patients ultimately required partial pancreatectomy for control of neuroglycopenia; pancreas pathology of all patients revealed diffuse islet hyperplasia and expansion of beta cell mass.CONCLUSIONS/INTERPRETATION: These findings suggest that gastric bypass-induced weight loss may unmask an underlying beta cell defect or contribute to pathological islet hyperplasia, perhaps via glucagon-like peptide 1-mediated pathways.
KW - Adult
KW - Aged
KW - Diazoxide
KW - Diet Therapy
KW - Dumping Syndrome
KW - Female
KW - Gastric Bypass
KW - Humans
KW - Hyperplasia
KW - Hypoglycemia
KW - Insulin
KW - Islets of Langerhans
KW - Male
KW - Middle Aged
KW - Octreotide
KW - Pancreas
KW - Pancreatectomy
U2 - 10.1007/s00125-005-1933-x
DO - 10.1007/s00125-005-1933-x
M3 - Journal article
C2 - 16195867
VL - 48
SP - 2236
EP - 2240
JO - Diabetologia
JF - Diabetologia
SN - 0012-186X
IS - 11
ER -
ID: 132053425