Post-prandial Hypoglycemia after Bariatric Surgery: Pharmacological Treatment with Verapamil and Acarbose Authors
First Online: 20 June 2008 Received: 17 March 2008 Accepted: 13 May 2008 DOI:
Cite this article as: Moreira, R.O., Moreira, R.B.M., Machado, N.A.M. et al. OBES SURG (2008) 18: 1618. doi:10.1007/s11695-008-9569-9 Abstract
Postprandial hypoglycemia is a common complication of bariatric surgery. It is usually caused by late dumping syndrome, but a few other causes have already been described, including insulinoma and noninsulinoma pancreatogenous hypoglycemic syndrome (NIPHS). Considering that NIPHS is a recently described syndrome and is also very rare, therapeutic approaches are still not consensual. We report the case of a 26-year-old woman who was submitted to bariatric surgery and presented episodic postprandial hypoglycemic episodes after 16 months. Fasting C-peptide, insulin, and glucose were normal. Because of the possibility of NIPHS, clinical treatment was initiated with verapamil and acarbose, leading to a significant reduction of hypoglycemic episodes and also their severity. Surgery is the most common approach to NIPHS. However, in cases of mild or moderate symptoms, it is important to consider the possibility of pharmacological treatment. This approach may result, at least for some time, in an amelioration of symptoms without the need of an aggressive procedure.
Keywords Noninsulinoma pancreatogenous hypoglycemic syndrome Obesity surgery Postprandial hypoglycemia Verapamil Acarbose References
Cummings DE. Gastric bypass and nesidioblastosis—to much of a good thing for islets? N Engl J Med. 2005;353:300–2.
Sjöström L, Lindroos A-K, Peltonen M, et al. Lifestyle, diabetes, and cardiovascular risk factors 10 years after bariatric surgery. N Engl J Med. 2004;351:2683–93.
Buchwald H, Avidor Y, Braunwald E, et al. Bariatric surgery: a systematic review and meta-analysis. JAMA. 2004;292:1724–37.
Service GJ, Thompson GB, Service FJ, et al. Hyperinsulinemic hypoglycemia with nesidioblastosis after gastric-bypass surgery. N Engl J Med. 2005;353:249–54.
Service FJ, Natt N, Thompson GB, et al. Noninsulinoma pancreatogenous hypoglycemia: a novel syndrome of hyperinsulinemic hypoglycemia in adults independent of mutations in Kir6.2 and SUR1 genes. J Clin Endocrinol Metab. 1999;84:1582–9.
Thompson GB, Service FJ, Andrews JC, et al. Noninsulinoma pancreatogenous hypoglycemia syndrome (NIPHS): an update in 10 surgically treated patients. Surgery. 2000;128:937–45.
Zagury L, Moreira RO, Guedes EP, et al. Insulinoma misdiagnosed as dumping syndrome after bariatric surgery. Obes Surg. 2004;14:120–3.
Patti ME, McMahon G, Mun EC, et al. Severe hypoglycaemia post-gastric bypass requiring partial pancreatectomy: evidence for inappropriate insulin secretion and pancreatic islet hyperplasia. Diabetologia. 2005;48:2236–40.
Ulbrecht JS, Schmeltz R, Aarons JH, et al. Insulinoma in a 94-year-old woman: long-term therapy with verapamil. Diabetes Care. 1986;9:186–8.
Hirshberg B, Cochran C, Skarulis MC, et al. Malignant insulinoma: spectrum of unusual clinical features. Cancer. 2005;104:264–72.
Usukura M, Yoneda T, Oda N, et al. Medical treatment of benign insulinoma using octreotide LAR: a case report. Endocr J. 2007;54:95–101.
Peter S. Acarbose and Idiopatic reactive hypoglycemia. Horm Res. 2003;60:166–7.
Ozgen AG, Hamulu F, Bayraktar F, et al. Long-term treatment with acarbose for the treatment of reactive hypoglycemia. Eat Weight Disord. 1998;3:136–40.
Tamura Y, Araki A, Chiba Y, et al. Postprandial reactive hypoglycemia in an oldest-old patient effectively treated with low-dose acarbose. Endocr J. 2006;53:767–71.
Gebhard B, Holst JJ, Biegelmayer C, et al. Postprandial GLP-1, norepinephrine, and reactive hypoglycemia in dumping syndrome. Dig Dis Sci. 2001;46:1915–23.
Sahloul R, Yaqub N, Driscoll HK, et al. Noninsulinoma pancreatogenous hypoglycemia syndrome: quantitative and immunohistochemical analyses of islet cells for insulin, glucagon, somatostatin, and pancreatic and duodenal homeobox protein. Endocr Pract. 2007;13:187–93.
D’Alessio D, Vahl TP. Glucagon-like peptide 1: evolution of an incretin into a treatment for diabetes. Am J Physiol Endocrinol Metab. 2004;286:E882–90.
Brubaker PL, Drucker DJ. Glucagon-like polypeptides regulate cell proliferation and apoptosis in the pancreas, gut, and central nervous system. Endocrinology. 2004;145:2653–9.
Meier JJ, Butler AE, Galasso R, Butler PC. Hyperinsulinemic hypoglycemia after gastric bypass surgery is not accompanied by islet hyperplasia or increased β-cell turnover. Diabetes Care. 2006;29:1554–9.
Won JG, Tseng HS, Yang AH, et al. Clinical features and morphological characterization of 10 patients with noninsulinoma pancreatogenous hypoglycaemia syndrome (NIPHS). Clin Endocrinol (Oxf). 2006;65:566–78.
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