| Popis: |
BackgroundInsulinomas are the most common neuroendocrine tumors of the pancreas, they are rarely suspected as a cause of hyperinsulinemia in morbidly obese patients because these patients have hyperinsulinemia as a result of insulin resistance. One of the complications of LRYGB is dumping syndrome. The pathophysiology of this hypoglycemia after LRYGB is not well understood, and many theories have been proposed such as excessive GLP-1, nesidioblastosis, and increased glucose effectiveness.Case PresentationA 37-year-old female patient with a past history of LRYGB 6 years ago, diagnosed as having late dumping syndrome because of complaints of perspiration, palpitations, hunger, fatigue, aggression, and confusion not related to eating. After the failure of dietician counseling to treat her symptoms, biochemical tests were performed to investigate other possible causes of her symptoms such as hyperinsulinemia, Oral Glucose Tolerance Test demonstrated deep hypoglycemia after 90 min. MRI and endoscopic ultrasound were performed and demonstrated the presence of a well differentiated endocrine tumor of approximately 1.8 cm in diameter in the body of the pancreas. ConclusionBariatric surgeons should be aware of metabolic conditions including hypoglycemia, as a treatable cause of dumping-like symptoms. |
