A Clinical Case of Insulinoma Presenting with Postprandial Hypoglycemia in a Patient with a History of Gastric Bypass Surgery
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- Hayashida Ryosuke
- Department of Endocrinology and Metabolism, Tokyo Metropolitan Tama Medical Center, Japan Department of Diabetes and Endocrinology, University of Yamanashi Hospital, Japan
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- Tsuchiya Kyoichiro
- Department of Diabetes and Endocrinology, University of Yamanashi Hospital, Japan
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- Sekine Tetsuo
- Department of Diabetes and Endocrinology, University of Yamanashi Hospital, Japan
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- Momose Takashi
- Department of Endocrinology and Metabolism, Tokyo Metropolitan Tama Medical Center, Japan
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- Sato Fuminori
- Department of Endocrinology and Metabolism, Tokyo Metropolitan Tama Medical Center, Japan
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- Sakurada Maya
- Department of Endocrinology and Metabolism, Tokyo Metropolitan Tama Medical Center, Japan
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- Nishida Kenji
- Department of Endocrinology and Metabolism, Tokyo Metropolitan Tama Medical Center, Japan
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- Hayashi Tatsuya
- Department of Gastrointestinal and General Surgery, Tokyo Metropolitan Tama Medical Center, Japan
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- Morita Yasuhiro
- Department of Gastrointestinal and General Surgery, Tokyo Metropolitan Tama Medical Center, Japan
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- Okada Haruka
- Department of Pathology, Tokyo Metropolitan Tama Medical Center, Japan
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- Fukushima Noriyoshi
- Department of Pathology, Jichi Medical University, Japan
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- Yamada Tetsuya
- Department of Molecular Endocrinology and Metabolism, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Japan
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- Tsujino Motoyoshi
- Department of Endocrinology and Metabolism, Tokyo Metropolitan Tama Medical Center, Japan
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Abstract
<p>A 61-year-old man with a history of total gastrectomy for cancer with Roux-en-Y reconstruction showed severe postprandial hypoglycemia accompanied by endogenous hyperinsulinemia. Abdominal ultrasonography and contrast-enhanced computed tomography showed no abnormal findings in the pancreas. A selective arterial secretagogue injection test showed the marked induction of serum immunoreactive insulin when calcium was injected into the splenic artery. A pathological analysis following distal pancreatectomy with splenectomy revealed a pancreatic neuroendocrine microadenoma containing insulin-producing cells in the resected pancreas. This case highlights the importance of carefully evaluating refractory and severe hypoglycemia in patients with a history of gastric surgery to exclude insulinoma. </p>
Journal
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- Internal Medicine
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Internal Medicine 61 (8), 1189-1195, 2022-04-15
The Japanese Society of Internal Medicine
