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

Research output: Contribution to journalJournal articleResearchpeer-review

M E Patti, G McMahon, E C Mun, A Bitton, Jens Juul Holst, J Goldsmith, D W Hanto, M Callery, R Arky, V Nose, S Bonner-Weir, A B Goldfine

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.

Original languageEnglish
JournalDiabetologia
Volume48
Issue number11
Pages (from-to)2236-40
Number of pages5
ISSN0012-186X
DOIs
Publication statusPublished - Nov 2005

    Research areas

  • Adult, Aged, Diazoxide, Diet Therapy, Dumping Syndrome, Female, Gastric Bypass, Humans, Hyperplasia, Hypoglycemia, Insulin, Islets of Langerhans, Male, Middle Aged, Octreotide, Pancreas, Pancreatectomy

ID: 132053425