A Clinical Case of Insulinoma Presenting with Postprandial Hypoglycemia in a Patient with a History of Gastric Bypass Surgery |
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Authors: | Ryosuke Hayashida Kyoichiro Tsuchiya Tetsuo Sekine Takashi Momose Fuminori Sato Maya Sakurada Kenji Nishida Tatsuya Hayashi Yasuhiro Morita Haruka Okada Noriyoshi Fukushima Tetsuya Yamada Motoyoshi Tsujino |
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Abstract: | A 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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Keywords: | hypoglycemia insulinoma |
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