Severe hypoglycaemia post-gastric bypass requiring partial pancreatectomy: evidence for inappropriate insulin secretion and pancreatic islet hyperplasia
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.
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.
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.
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.
- Severe hypoglycaemia post-gastric bypass requiring partial pancreatectomy: evidence for inappropriate insulin secretion and pancreatic islet hyperplasia
Volume 48, Issue 11 , pp 2236-2240
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- Gastric bypass
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- Author Affiliations
- 1. Research Division, Joslin Diabetes Center, 1 Joslin Place, Boston, MA, 02215, USA
- 2. Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
- 3. Harvard Medical School, Boston, MA, USA
- 4. Department of Medicine, Brigham and Women’s Hospital, Boston, MA, USA
- 5. Department of Surgery, Beth Israel Deaconess Medical Center, Boston, MA, USA
- 6. Department of Medical Physiology, University of Copenhagen, Copenhagen, Denmark
- 7. Department of Pathology, Beth Israel Deaconess Medical Center, Boston, MA, USA
- 8. Department of Pathology, Brigham and Women’s Hospital, Boston, MA, USA