Short communication

Diabetologia

, Volume 48, Issue 11, pp 2236-2240

Severe hypoglycaemia post-gastric bypass requiring partial pancreatectomy: evidence for inappropriate insulin secretion and pancreatic islet hyperplasia

  • M. E. PattiAffiliated withResearch Division, Joslin Diabetes CenterDepartment of Medicine, Beth Israel Deaconess Medical CenterHarvard Medical School Email author 
  • , G. McMahonAffiliated withDepartment of Medicine, Brigham and Women’s Hospital
  • , E. C. MunAffiliated withDepartment of Medicine, Beth Israel Deaconess Medical CenterHarvard Medical SchoolDepartment of Surgery, Beth Israel Deaconess Medical Center
  • , A. BittonAffiliated withDepartment of Medicine, Brigham and Women’s Hospital
  • , J. J. HolstAffiliated withDepartment of Medical Physiology, University of Copenhagen
  • , J. GoldsmithAffiliated withHarvard Medical SchoolDepartment of Pathology, Beth Israel Deaconess Medical Center
  • , D. W. HantoAffiliated withHarvard Medical SchoolDepartment of Surgery, Beth Israel Deaconess Medical Center
  • , M. CalleryAffiliated withHarvard Medical SchoolDepartment of Surgery, Beth Israel Deaconess Medical Center
  • , R. ArkyAffiliated withHarvard Medical SchoolDepartment of Medicine, Brigham and Women’s Hospital
    • , V. NoseAffiliated withHarvard Medical SchoolDepartment of Pathology, Brigham and Women’s Hospital
    • , S. Bonner-WeirAffiliated withResearch Division, Joslin Diabetes CenterHarvard Medical School
    • , A. B. GoldfineAffiliated withResearch Division, Joslin Diabetes CenterDepartment of Medicine, Beth Israel Deaconess Medical CenterHarvard Medical School

Abstract

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.

Keywords

Gastric bypass GLP1 Glucagon-like peptide 1 Hypoglycaemia Incretin Insulin Obesity