PDF(Pubmed)
Abstract：
Bariatric surgery is a procedure performed to achieve weight loss and manage obesity. However, it can result in various complications including post-surgical hypoglycemia. Nesidioblastosis is a rare hypoglycemic syndrome marked by diffuse hyperplasia of pancreatic β cells with distinct histologic features. Recent case reports have indicated an association of nesidioblastosis with certain bariatric procedures, often specifically linked to Roux-en-Y gastric bypass (RYGB) surgery. In this case report, we describe a 78-year-old male with a complex medical history who presented with altered mental status and severe hypoglycemia (13 mg/dL), despite having no history of diabetes or use of hypoglycemic medications. The patient\'s clinical condition improved after receiving a 50% intravenous dextrose injection and subsequently placed on a 10% dextrose infusion. Adrenal insufficiency was ruled out with normal cortisol level, and tests for β-hydroxybutyrate, dehydroepiandrosterone (DHEA) sulfate, and hypoglycemia panels were all negative. However, further investigations were significant for elevated serum insulin, C-peptide, and proinsulin levels. The patient then underwent an abdominal computed tomography (CT) scan, which revealed a grossly normal liver, spleen, pancreas, and adrenal glands, along with evidence of prior gastric bypass surgery. Further evaluation confirmed a history of Roux-en-Y gastric bypass surgery, which was performed to address morbid obesity and obstructive sleep apnea. Following the procedure, the patient began experiencing hypoglycemic episodes. Subsequently, the patient was diagnosed with hyperinsulinemic hypoglycemia with possible nesidioblastosis. This diagnosis was made based on severe recurrent postprandial hypoglycemia, accompanied by elevated endogenous insulin production, and a pancreas that appeared grossly normal on imaging. The patient was treated with acarbose to prevent carbohydrate-driven blood sugar and insulin spikes, octreotide to inhibit insulin secretion, and dietary guidance to avoid high glycemic index foods. This case emphasizes the potential link between bariatric surgeries and metabolic disturbances, underscoring the importance of identifying uncommon hypoglycemic syndromes.
摘要：
减肥手术是为了实现体重减轻和控制肥胖而进行的手术。然而,它会导致各种并发症，包括术后低血糖。Nesidioblastic是一种罕见的低血糖综合征，其特征是胰腺β细胞弥漫性增生，具有独特的组织学特征。最近的病例报告表明，成釉细胞病与某些减肥手术有关，通常与Roux-en-Y胃旁路术（RYGB）手术有关。在这个案例报告中,我们描述了一名78岁的男性，有复杂的病史，他的精神状态改变和严重的低血糖（13mg/dL），尽管没有糖尿病史或使用降糖药物。患者的临床状况在接受50％的葡萄糖静脉注射并随后接受10％的葡萄糖输注后得到改善。肾上腺功能不全被排除，皮质醇水平正常，和β-羟基丁酸的测试，脱氢表雄酮（DHEA）硫酸盐，低血糖面板均为阴性.然而,进一步的调查对血清胰岛素升高有重要意义，C-肽，和胰岛素原水平。然后患者接受了腹部计算机断层扫描（CT）扫描，显示肝脏非常正常，脾,脾胰腺,和肾上腺，以及之前胃旁路手术的证据.进一步评估证实了Roux-en-Y胃旁路手术史，这是为了解决病态肥胖和阻塞性睡眠呼吸暂停。按照程序，患者开始出现低血糖发作.随后，该患者被诊断为高胰岛素血症性低血糖伴可能的肾母细胞病.该诊断是基于严重的餐后低血糖复发，伴随着内源性胰岛素产生的增加，和胰腺在成像上看起来非常正常。患者接受了阿卡波糖治疗，以防止碳水化合物驱动的血糖和胰岛素峰值，奥曲肽抑制胰岛素分泌，和饮食指导，以避免高血糖指数食物。这个案例强调了减肥手术和代谢紊乱之间的潜在联系，强调识别不常见的低血糖综合征的重要性。
