Monday April 3, 2006
Nesidioblastosis - post gastric bypass complication
Case: 40 years old non-diabetic female, reliable historian, admitted to ICU with life threatening and persistent hypoglycemia. Patient is not on any medication and past medical and surgical history is significant only with gastric bypass surgery 2 years ago. Surgical service decide to take patient to OR.
As gastric bypass procedures are growing in number, Nesidioblastosis (hyperinsulinemic hypoglycemia) is now a documented complication of gastric bypass surgery particularly Roux-en-Y gastric bypass surgery. Patients may present with repeated episodes of profound hypoglycemia which are actually postprandial neuroglycopenia associated with endogenous hyperinsulinemic hypoglycemia. Diagnosis is confirmed by selective arterial calcium-stimulation testing and treatment is partial pancreatectomy. Peri and post-operatively diffuse beta-cell hypertrophy and hyperplasia has been demonstrated (and resected). The exact mechanism is not clear though various explanations has been suggested.
Read very nice review here from Edward E. Mason MD, Ph.D.(University of Iowa health care).
References: (click to get abstract)
1. Gastric Bypass and Nesidioblastosis — Too Much of a Good Thing for Islets? - NEJM , Volume 353:300-302 - July 21, 2005
2. Nesidioblastosis - emedicine.com