Late post-prandial hypoglycaemia as the sole presenting feature of secreting pancreatic beta-cell adenoma in a subtotally gastrectomized patient
| Autor: | K. Polonsky, S. Pampanelli, Fausto Santeusanio, Carmine G. Fanelli, Elisabetta Torlone, Paolo Brunetti, P. Del Sindaco, G. Casucci, Geremia B. Bolli |
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| Jazyk: | angličtina |
| Rok vydání: | 1997 |
| Předmět: |
Blood Glucose
Male medicine.medical_specialty Pancreatic disease endocrine system diseases Adenoma Endocrinology Diabetes and Metabolism Hypoglycemia Diagnosis Differential Endocrinology Gastrectomy Internal medicine medicine Diazoxide Humans Insulin Insulinoma Proinsulin Reactive hypoglycemia C-Peptide business.industry General Medicine Glucose Tolerance Test Middle Aged Postprandial Period medicine.disease Pancreatic Neoplasms medicine.anatomical_structure Pancreas business hormones hormone substitutes and hormone antagonists Follow-Up Studies medicine.drug |
| Popis: | In this paper we describe for the first time late post-prandial hypoglycaemia as the sole presenting feature of an insulinoma in a patient who had previously undergone subtotal gastrectomy. The symptoms of hypoglycaemia always occurred 1–3 h after meals, not in the fasting state. Because of the history of gastrectomy and because post-prandial hypoglycaemia was reproduced by an oral glucose tolerance test, the diagnosis of reactive hypoglycaemia was made. Eighteen months later a fasting test was performed: venous plasma glucose decreased from 3·8 mmol/l to 2·7 mmol/l between 14 and 20 h of fast while plasma immunoreactive insulin did not decrease and plateaued at 185 pmol/l. Plasma C-peptide (0·9 nmol/l) and proinsulin (70 pmol/l, split 64, 65) were also elevated. All islet hormones increased in response to i.v. glucose and were suppressed after diazoxide. Although pre-operative procedures were negative in localizing an insulinoma, the patient underwent an operation and an insulinoma was detected at the body level of the pancreas. Thus, insulinoma should be considered in the differential diagnosis of reactive hypoglycaemia in gastrectomized patients. Response of islet hormones to glucose and their suppression by diazoxide are evidence of a secreting insulinoma even in the absence of preoperative localization of the pancreatic adenoma. European Journal of Endocrinology 136 96–99 |
| Databáze: | OpenAIRE |
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