Endocrine Abstracts

Introduction: Today, approximately 33% of the world population is either overweight or obese. National Health and Nutrition Examination Survey (NHANES) results show that, when 20 years and older American adults are examined, it is seen that 33% of them are overweight, 35.7% of them are obese, and 6.3% of them are morbidly obese (1). Roux-en-Y gastric bypass is a restrictive and malabsorptive combined method and is a complicated operation. Cases of endogenous hyperinsulinemic hypoglycemia developing an average of 5-6 years after the operation have been reported (2). We aimed to present a case of severe hypoglycemia after Roux-en-Y gastric bypass.

Case: A 27-year-old female patient had a sleeve gastrectomy in 2015 and a Roux-en-Y gastric bypass operation in 2018. She lost 76 kg after the operation. His hypoglycemia started one year after Roux-en-Y gastric bypass. The patient, who has tremors, sweating, and palpitations, especially 2-4 hours after the meal, states that his capillary blood sugar is 24 mg/dl. Therefore, the patient sometimes applied to the emergency room. The patient was interned at Bursa Uludağ University in 2019. At the 15th hour of the 72-hour fasting test, blood glucose was: 20 mg/dl Insulin: 19.2 pmol/l c-peptide: 7 ng/ml. At the 2nd hour of the mixed meal test, blood glucose was 47 mg/dl while insulin: was 43.4 pmol/l. Computed tomography (CT) was performed on the patient. The pancreas was normal in CT. Islet abnormalities after Roux-en-Y gastric bypass surgery were considered in the patient. The patient received acarbose and metformin treatments for three months, but to no avail. Then liraglutide was started. After a month, the controlled hypoglycemia continued, and isoptin and acarbose were added to his treatment. However, the patient’s complaints continued. Thereupon, Octreotide LAR 20 mg was started. The patient whose hypoglycemia improved is being followed up. ConclusionIt is necessary to be careful about hypoglycemia developing after Roux-en-Y gastric bypass. Also, we should consider the long-term results of bariatric surgery when making an operational decision. Octreotide therapy may be an alternative to pancreatectomy in hypoglycemia developing after gastric bypass.

References

1. Forse RA, Betancourt-Garcia MM, Kissee MC. Epidemiology and discrimination in obesity. In: The ASMBS textbook of bariatric surgery. Springer; 2020. p. 3–14.

2. Service GJ, Thompson GB, Service FJ, Andrews JC, Collazo-Clavell ML, Lloyd RV Hyperinsulinemic hypoglycemia with nesidioblastosis after gastric-bypass surgery. N Engl J Med. 2005; 353 (3):249.