Endocrine Abstracts

Introduction: Case reports of individuals with non-insulinoma hyperinsulinic hypoglcaemia of organic origin has been more frequently described in literature. This syndrome has been described as a rare complication of bariatric surgeries and the term of NIPHS (non-insulinoma pancreatogenic hypoglycemia syndrome) has been proposed.

Aim: The aim of our study is to present patients case who had previously undergone the gastric surgery. Bilroth II and finally diagnosed of NIPHS.

Case description: A 45-year-old man who had previously undergone gastric surgery, was refered to our hospital for evaluation of hypoglycemia. At the beginning, the patient experienced only episodes of postprandial hypoglycaemia and subsequently episodes of fasting hypoglycaemia appeared. Diagnostic imaging including ultrasound, CT, Octreoscan and EUS were negative for the patient. Post-operative changes and chronic pancreatitis impeded the interpretation of obtained results. Farmacological treatment with Proglicem or somatostatine analogues led only to transient improvement in control of hypoglycemic status.

Because pharmacological treatment was ineffective patient undergone partial pancreatectomy.

Finally the diagnosis of NIPHS has been established based on postoperative histological diagnosis established after partial pancreatectomy.

Conclusion: 1. NIPHS must always be considered in differential diagnosis of adult patients with hypoglycaemia.

2. NIPHS may occur not only in patients after bariatric surgeries but also after gastric surgeries caused by peptic ulcer.