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[Postalimentary hypoglycaemia in post-gastrectomy late dumping syndrome]
M Thalhammer1, A Cuk, K-D Palitzsch
13. Medizinische Abteilung, Krankenhaus München Neuperlach. palitzsch@extern.lrz-muenchen.de
Deutsche Medizinische Wochenschrift (1946)
|February 18, 2005
Summary
Postalimentary hypoglycemia, often linked to late dumping syndrome, can be diagnosed via oral glucose tolerance tests and gastric emptying scintigraphy. Octreotide offers a promising treatment option with manageable side effects.
Area of Science:
- Gastroenterology
- Endocrinology
- Surgical Research
Background:
- A patient presented with recurrent postprandial hypoglycemia, a condition characterized by low blood sugar after meals.
- Previous surgeries included fundoplication and proximal vagotomy for reflux esophagitis, potentially impacting gastric function.
Observation:
- Clinical examination showed no abnormalities, but glucose monitoring revealed significant postprandial drops to 20 mg/dl.
- Oral glucose tolerance tests indicated excessive insulin secretion, with an elevated insulin/glucose index.
- Gastric emptying scintigraphy confirmed altered gastric motility, specifically delayed then accelerated emptying post-vagotomy.
Findings:
- The diagnosis was postalimentary hypoglycemia secondary to hyperinsulinism within a late dumping syndrome context, likely exacerbated by prior surgery.
- Surgical pyloroplasty proved ineffective in managing the condition.
Implications:
- Postalimentary hypoglycemia is frequently associated with late dumping syndrome, diagnosable through specific tests.
- Octreotide, a somatostatin analogue, presents a viable therapeutic strategy with a favorable side effect profile for managing this condition.