[Postalimentary hypoglycaemia in post-gastrectomy late dumping syndrome].

Abstract

HISTORY AND CLINICAL FINDINGS:

A 48-year-old patient had been suffering from postalimentary hypoglycemias for several months, occurring regularly 2 hours after a meal. 5 years before, repeated fundaplications as well as a selective proximal vagotomy due to reflux oesophagitis had been performed.

INVESTIGATIONS:

Physical examination revealed no pathological findings. The diurnal blood sugar profile with hourly capillary glucose measurement showed a physiological fasting glucose homeostasis and two-hour postprandial decrease of blood glucose down to 20 mg/dl. The oral glucose tolerance test revealed a noticeable insulin secretion with a pathologically increased insulin/glucose index. Scintigraphy demonstrated an initially delayed, then accelerated gastric emptying as a consequence of the selective proximal vagotomy.

DIAGNOSIS, TREATMENT AND COURSE:

A postalimentary hypoglycemia by hypersecretion of insulin in the context of a post-gastrectomy late dumping syndrome was diagnosed. A surgical pyloroplasty was not effective. In addition to the modification of eating habits, treatment with subcutaneous applied octreotide (Sandostatin), a somatostatin-analogue, was initiated.

CONCLUSIONS:

Postalimentary hypoglycemia can be assigned to late dumping syndrome in most cases already by ascribed history taking. The correct diagnosis can be achieved by an oral glucose tolerance test with measurement of insulin secretion and gastric emptying scintigraphy. Beside other therapeutical options the treatment with octreotide is a promising alternative with manageable side effects.

• Authors: M Thalhammer, A Cuk, K-D Palitzsch
• Journal: Deutsche medizinische Wochenschrift (1946) (Dtsch Med Wochenschr) Vol. 130 Issue 8 Pg. 393-6 (Feb 25 2005) ISSN: 0012-0472 [Print] Germany
• Vernacular Title: Postalimentäre Hypoglykämien bei Spätdumping-Syndrom.
• PMID: 15717249 (Publication Type: Case Reports, Journal Article)

Chemical References

• Blood Glucose
• Gastrointestinal Agents
• Insulin
• Octreotide

Topics

• Area Under Curve
• Blood Glucose (metabolism)
• Dumping Syndrome (complications, physiopathology, therapy)
• Gastrectomy (adverse effects)
• Gastric Emptying (drug effects, physiology)
• Gastrointestinal Agents (therapeutic use)
• Glucose Tolerance Test
• Humans
• Hypoglycemia (etiology)
• Insulin (metabolism)
• Insulin Secretion
• Male
• Middle Aged
• Octreotide (therapeutic use)
• Treatment Outcome