• Internal medicine · Apr 2022

    Case Reports

    A Clinical Case of Insulinoma Presenting with Postprandial Hypoglycemia in a Patient with a History of Gastric Bypass Surgery.

    • Ryosuke Hayashida, Kyoichiro Tsuchiya, Tetsuo Sekine, Takashi Momose, Fuminori Sato, Maya Sakurada, Kenji Nishida, Tatsuya Hayashi, Yasuhiro Morita, Haruka Okada, Noriyoshi Fukushima, Tetsuya Yamada, and Motoyoshi Tsujino.
    • Department of Endocrinology and Metabolism, Tokyo Metropolitan Tama Medical Center, Japan.
    • Intern. Med. 2022 Apr 15; 61 (8): 118911951189-1195.

    AbstractA 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.

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