Hyperinsulinemic Hypoglycemia after Bariatric Surgery: Diagnosis and Management Experience from a Spanish Multicenter Registry

Abstract

Background: Severe postprandial hypoglycemia after bariatric surgery is a rare but invalidating complication. Our aim was to describe the different tests performed for its diagnosis and their outcomes as well as the response to the prescribed pharmacological and surgical treatments. Methods: Multicenter, retrospective systematic review of cases with recurrent severe postprandial hypoglycemia. Results: Over 11 years of follow-up, 22 patients were identified. The test most used to provoke hypoglycemia was the oral glucose load test followed by the mixed meal test which was the least standardized test. With pharmacological treatment, 3 patients were symptom-free (with octreotide) and in 12 patients hypoglycemic episodes were attenuated. Seven patients had persistent hypoglycemic episodes and underwent surgery. Partial pancreatectomy was performed in 3 patients who had positive selective arterial calcium stimulation, and nesidioblastosis was confirmed in 2 patients. Reconversion to normal anatomy was performed in 3 patients, and 1 patient underwent a resection of the ‘candy cane' roux limb, with resolution of hypoglycemia in all cases. Conclusions: There is high heterogeneity in the evaluation and treatment options for postoperative hypoglycemia. In patients that do not respond to pharmacological treatment, reconstruction of gastrojejunal continuity may be the safest and most successful procedure.

Journal

Journal ID (publisher-id): OFA

Journal ID (pmc): OFA

Journal ID (nlm-ta): Obes Facts

Journal ID (doi): 10.1159/issn.1662-4025

Title: Obesity Facts

Publisher: S. Karger AG

ISSN (Print): 1662-4025

ISSN (Electronic): 1662-4033

Publication date Subscription-year: 2016

Publication date (Print): March 2016

Publication date (Electronic): 23 February 2016

Volume: 9

Issue: 1

Pages: 41-51

Affiliations

^aDepartment of Endocrinology and Nutrition, Hospital Universitario de Bellvitge-IDIBELL, L´Hospitalet de Llobregat, Barcelona, Spain; ^bCIBERDEM-CIBER de Diabetes y Enfermedades Metabólicas Asociadas. Instituto de Salud Carlos III, Madrid, Spain.; ^cEndocrinology and Nutrition Unit, Hospital del Mar, Barcelona, IMIM, Institut Mar dʼInvestigacions, Barcelona, Spain; ^dDepartment of Medicine, Universitat Autònoma de Barcelona, CIBERobn (Centros de Investigación Biomédica en Red - CIBER, Physiopathology of Obesity and Nutrition), Instituto de Salud Carlos III, Madrid, Spain; ^eDepartment of Endocrinology & Nutrition, Hospital Clínico San Carlos. IDISSC, Madrid, Spain; ^fEndocrinology and Nutrition Department, Sabadell University Hospital (UAB), Corporació Sanitària Parc Taulí, Sabadell, Spain; ^gEndocrinology and Nutrition Department, IMPPC, Hospital Universitari Germans Trias i Pujol, Barcelona, Spain; ^hCIBERDEM-CIBER de Diabetes y Enfermedades Metabólicas Asociadas. Instituto de Salud Carlos III, Madrid, Spain; ⁱEndocrinology and Nutrition Department. Morbid Obesity Unit, Hospital Vall d´Hebron, Barcelona, Spain; ^jEndocrinology and Nutrition Department, Hospital Universitario Reina Sofía, Córdoba, Spain; ^jEndocrinology and Nutrition Department, Hospital Universitario Ramón y Cajal, IRyCIS y CIBERobn, Madrid, Spain; ^kEndocrinology and Nutrition Department, Hospital Universitario Gregorio Marañón, Madrid, Spain; ^lHospital del Meixoeiro, Vigo, Spain; ^mDepartment of Endocrinology and Nutrition, Hospital Valle del Nalon., Riaño, Spain; ⁿU. Nutricion. U.G. Endocrinologia y Nutricion, Hospital Universitario Virgen del Rocío, Sevilla, Spain; ^oEndocrinology and Nutrition Department, Hospital Universitari Arnau de Vilanova, Lleida, Spain

Author notes

*Nuria Vilarrasa, Hospital Universitario de Bellvitge - IDIBELL, C/ Feixa Llarga s/n, L´Hospitalet de Llobregat, 08907 Barcelona, Spain, [e-mail]

Article

Publisher ID: 442764 Other ID: Obes Facts 2016;9:41-51

DOI: 10.1159/000442764

PMC ID: 5644871

PubMed ID: 26901345

Copyright statement: © 2016 S. Karger GmbH, Freiburg

License:

Open Access License: This is an Open Access article licensed under the terms of the Creative Commons Attribution-NonCommercial 3.0 Unported license (CC BY-NC) ( http://www.karger.com/OA-license), applicable to the online version of the article only. Distribution permitted for non-commercial purposes only. Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug. Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

Page count

Figures: 3, Tables: 3, References: 38, Pages: 11

Product

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Categories

Subject: Original Article