Noninsulinoma pancreatogenous hypoglycemia syndrome: an update in 10 surgically treated patients.

Abstract

BACKGROUND:

Neuroglycopenia from endogenous hyperinsulinism usually is caused by insulinomas in adults. We recently reported a novel hypoglycemic disorder in 5 patients (patients 1 to 5) with postprandial neuroglycopenia, negative 72-hour fasts, negative perioperative imaging studies, but positive calcium stimulation tests and islet hypertrophy and nesidioblastosis in the gradient-guided resected pancreata.

METHODS:

In this report we compare our experience with 5 additional patients (patients 6 to 10) with this syndrome to that in the original report.

RESULTS:

The clinical features of patients 6 to 10 were similar to those of patients 1 to 5. Each had positive calcium stimulation testing that guided the extent of the distal pancreatectomy and histologic evidence of islet cell hypertrophy or nesidioblastosis. All 10 patients are alive from 9 to 50 months after operation, 1 of whom had no amelioration of neuroglycopenia. Minor perioperative complications occurred in 3 patients. One patient has experienced repeated bouts of acute pancreatitis, pseudocyst formation, and exocrine insufficiency.

CONCLUSIONS:

We have identified adult patients with severe, postprandial hyperinsulinemic hypoglycemia from diffuse islet cell disease, 80% of whom have been well palliated with surgery. The results in 7 men have been better than those in the 3 women for reasons that are not obvious.

• Authors: G B Thompson, F J Service, J C Andrews, R V Lloyd, N Natt, J A van Heerden, C S Grant
• Journal: Surgery (Surgery) Vol. 128 Issue 6 Pg. 937-44;discussion 944-5 (Dec 2000) ISSN: 0039-6060 [Print] United States
• PMID: 11114627 (Publication Type: Journal Article)

Chemical References

• Calcium

Topics

• Adolescent
• Adult
• Aged
• Calcium (pharmacology)
• Female
• Humans
• Hypoglycemia (pathology, surgery)
• Male
• Middle Aged
• Pancreatectomy
• Postoperative Complications
• Syndrome