A case of severe hypoglycemia after gastric bypass surgery in a woman with non-alcoholic fatty liver disease (NAFLD)

Authors

  • GONZALO Hospital Nacional Dos de Mayo. Lima, Perú. Universidad de San Martín de Porres, Facultad de Medicina Humana. Lima, Perú. Médico asistente de endocrinología, exresidente de endocrinología. Magister en Docencia e Investigación, docente. https://orcid.org/0000-0003-0162-1952

DOI:

https://doi.org/10.24265/horizmed.2022.v22n4.10

Keywords:

Hypoglycemia , Gastric Bypass, Obesity, Fatty Liver

Abstract

Post-gastric bypass hypoglycemia is characterized by postprandial hypoglycemia with pancreatic islet-cell hypertrophy in patients who have undergone a bariatric surgery and may be prone to hypoglycemia due to NAFLD, obesity, and impaired insulin and glucagon secretion.
We present the case of a 44-year-old obese woman with NAFLD who underwent a Roux-en-Y gastric bypass and years later presented with severe hypoglycemia. She was diagnosed with endogenous hyperinsulinemic hypoglycemia and beta-cell hyperplasia.
Post-gastric bypass hypoglycemia is a scenario that will be faced more often; therefore, it is important to take it into account for a timely treatment.

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References

Craig CM, McLaughlin TL. Defining clinically important hypoglycemia in patients with postbariatric hypoglycemia. Surg Obes Relat Dis. 2021; 17(11): 1865-72.

Oki Y, Ono M, Hyogo H, Ochi T, Munekage K, Nozaki Y, et al. Evaluation of postprandial hypoglycemia in patients with nonalcoholic fatty liver disease by oral glucose tolerance testing and continuous glucose monitoring. Eur J Gastroenterol Hepatol. 2018; 30(7): 797-805.

Lee JY, Kim Y, Han K, Han E, Lee BW, Kang ES, et al. Analysis of severe hypoglycemia among adults with type 2 diabetes and nonalcoholic fatty liver disease. JAMA Netw Open. 2022; 5(2): e220262.

Honka H, Salehi M. Postprandial hypoglycemia after gastric bypass surgery: from pathogenesis to diagnosis and treatment. Curr Opin Clin Nutr Metab Care. 2019; 22(4): 295-302.

Wong M, Conway L, Cooper C, Sinha A, Nandi N. Nesidioblastosis in an adult with short gut syndrome and type 2 diabetes. AACE Clin Case Rep. 2019; 5(6): e375-9.

Salehi M, Vella A, McLaughlin T, Patti ME. Hypoglycemia after gastric bypass surgery: current concepts and controversies. J Clin Endocrinol Metab. 2018; 103(8): 2815-26.

Bernard B, Kline GA, Service FJ. Hypoglycemia following upper gastrointestinal surgery: case report and review of the literature. BMC Gastroenterol. 2010; 10: 77.

Ritz P, Hanaire H. Post-bypass hypoglycaemia: a review of current findings. Diabetes Metab. 2011; 37(4): 274-81.

Deitel M. The change in the dumping syndrome concept. Obes Surg. 2008; 18(12): 1622-4.

Perez-Montes de Oca A, Pellitero S, Puig-Domingo M. Hypoglycemia after bariatric surgery: importance of exhaustive hormonal study. Endocrinol Diabetes Metab Case Rep. 2021; 2021: 20-0131

Costa ACC, Furtado MCMB, Godoy EP, Pontes ERJC, Tognini JRF, Ivo ML. Perda insuficiente de peso e ou ausência de remissão da diabete melito tipo 2 após a derivação gástrica em Y-de-Roux: fatores que podem influenciar os resultados insatisfatórios. Arq Bras Cir Dig. 2013; 26(2): 112-6.

Fischer LE, Wolfe BM, Fino N, Elman MR, Flum DR, Mitchell JE, et al. Postbariatric hypoglycemia: symptom patterns and associated risk factors in the Longitudinal Assessment of Bariatric Surgery study. Surg Obes Relat Dis. 2021; 17(10): 1787-98.

Jammah AA. Endocrine and metabolic complications after bariatric surgery. Saudi J Gastroenterol. 2015; 21(5): 269-77.

Sampaio-Neto J, Branco-Filho AJ, Nassif LS, Nassif AT, Masi FDD, Ximenez DR. Proposal of a revisional surgery to treat non-insulinoma hyperinsulinemic hypoglicemia postgastric bypass. Arq Bras Cir Dig. 2015; 28(4): 278-81.

Published

2022-12-07

How to Cite

1.
Miranda Manrique G. A case of severe hypoglycemia after gastric bypass surgery in a woman with non-alcoholic fatty liver disease (NAFLD). Horiz Med [Internet]. 2022Dec.7 [cited 2024Sep.19];22(4):e1957. Available from: https://www.horizontemedico.usmp.edu.pe/index.php/horizontemed/article/view/1957