Algorithm to diagnose etiology of hypoglycemia after Roux-en-Y gastric bypass for morbid obesity: Case series and review of the literature

Eugene P. Ceppa, Mimi Ceppa, Philip A. Omotosho, James A. Dickerson, Chan W. Park, Dana D. Portenier

Research output: Contribution to journalArticle

29 Citations (Scopus)

Abstract

Background: Gastric bypass is a proven treatment option for weight loss and the reduction of medical co-morbid conditions in the obese population. Severe refractory and/or recurrent hypoglycemia can occur, especially in postoperative patients who do not comply with the guidelines for oral glucose consumption. In a very small number of patients, the cause is not dietary indiscretions but, instead, factitious insulin administration or nesidioblastosis. The optimal evaluation and management for these diagnoses is not completely lucid yet important for bariatric surgeons and physicians alike to be familiar. Our objectives were to review the appropriate evaluation and treatment options for etiologies of hypoglycemia after gastric bypass and to create an algorithm that biochemically assesses the etiology of hypoglycemia. The setting was a university hospital in the United States. Methods: We present the cases of 3 patients who developed symptomatic hypoglycemia from distinct etiologies after laparoscopic Roux-en-Y gastric bypass. We also reviewed the current data regarding diagnosis and treatment. Results: Each patient's evaluation and management is elaborated in detail. We propose a novel algorithm for the biochemical evaluation of hypoglycemia after gastric bypass according to our experience and the review of the literature. Conclusion: Most cases of symptomatic hypoglycemia that develop in gastric bypass patients are associated with dietary indiscretions. However, a small subset of patients can develop refractory, recurrent, hyperinsulinemic hypoglycemia from factitious insulin administration or nesidioblastosis.

Original languageEnglish (US)
Pages (from-to)641-647
Number of pages7
JournalSurgery for Obesity and Related Diseases
Volume8
Issue number5
DOIs
StatePublished - Sep 2012
Externally publishedYes

Fingerprint

Gastric Bypass
Morbid Obesity
Hypoglycemia
Nesidioblastosis
Weight Loss
Insulin
Bariatrics
Therapeutics
Guidelines
Physicians
Glucose
Population

Keywords

  • Distal pancreatectomy
  • Dumping syndrome
  • Factitious insulin administration
  • Gastric bypass
  • Hyperinsulinemia
  • Hypoglycemia
  • Morbid obesity
  • Nesidioblastosis
  • Pancreaticoduodenectomy

ASJC Scopus subject areas

  • Surgery

Cite this

Algorithm to diagnose etiology of hypoglycemia after Roux-en-Y gastric bypass for morbid obesity : Case series and review of the literature. / Ceppa, Eugene P.; Ceppa, Mimi; Omotosho, Philip A.; Dickerson, James A.; Park, Chan W.; Portenier, Dana D.

In: Surgery for Obesity and Related Diseases, Vol. 8, No. 5, 09.2012, p. 641-647.

Research output: Contribution to journalArticle

Ceppa, Eugene P. ; Ceppa, Mimi ; Omotosho, Philip A. ; Dickerson, James A. ; Park, Chan W. ; Portenier, Dana D. / Algorithm to diagnose etiology of hypoglycemia after Roux-en-Y gastric bypass for morbid obesity : Case series and review of the literature. In: Surgery for Obesity and Related Diseases. 2012 ; Vol. 8, No. 5. pp. 641-647.
@article{396965674e154c4e9f759ebf645da0dd,
title = "Algorithm to diagnose etiology of hypoglycemia after Roux-en-Y gastric bypass for morbid obesity: Case series and review of the literature",
abstract = "Background: Gastric bypass is a proven treatment option for weight loss and the reduction of medical co-morbid conditions in the obese population. Severe refractory and/or recurrent hypoglycemia can occur, especially in postoperative patients who do not comply with the guidelines for oral glucose consumption. In a very small number of patients, the cause is not dietary indiscretions but, instead, factitious insulin administration or nesidioblastosis. The optimal evaluation and management for these diagnoses is not completely lucid yet important for bariatric surgeons and physicians alike to be familiar. Our objectives were to review the appropriate evaluation and treatment options for etiologies of hypoglycemia after gastric bypass and to create an algorithm that biochemically assesses the etiology of hypoglycemia. The setting was a university hospital in the United States. Methods: We present the cases of 3 patients who developed symptomatic hypoglycemia from distinct etiologies after laparoscopic Roux-en-Y gastric bypass. We also reviewed the current data regarding diagnosis and treatment. Results: Each patient's evaluation and management is elaborated in detail. We propose a novel algorithm for the biochemical evaluation of hypoglycemia after gastric bypass according to our experience and the review of the literature. Conclusion: Most cases of symptomatic hypoglycemia that develop in gastric bypass patients are associated with dietary indiscretions. However, a small subset of patients can develop refractory, recurrent, hyperinsulinemic hypoglycemia from factitious insulin administration or nesidioblastosis.",
keywords = "Distal pancreatectomy, Dumping syndrome, Factitious insulin administration, Gastric bypass, Hyperinsulinemia, Hypoglycemia, Morbid obesity, Nesidioblastosis, Pancreaticoduodenectomy",
author = "Ceppa, {Eugene P.} and Mimi Ceppa and Omotosho, {Philip A.} and Dickerson, {James A.} and Park, {Chan W.} and Portenier, {Dana D.}",
year = "2012",
month = "9",
doi = "10.1016/j.soard.2011.08.008",
language = "English (US)",
volume = "8",
pages = "641--647",
journal = "Surgery for Obesity and Related Diseases",
issn = "1550-7289",
publisher = "Elsevier Inc.",
number = "5",

}

TY - JOUR

T1 - Algorithm to diagnose etiology of hypoglycemia after Roux-en-Y gastric bypass for morbid obesity

T2 - Case series and review of the literature

AU - Ceppa, Eugene P.

AU - Ceppa, Mimi

AU - Omotosho, Philip A.

AU - Dickerson, James A.

AU - Park, Chan W.

AU - Portenier, Dana D.

PY - 2012/9

Y1 - 2012/9

N2 - Background: Gastric bypass is a proven treatment option for weight loss and the reduction of medical co-morbid conditions in the obese population. Severe refractory and/or recurrent hypoglycemia can occur, especially in postoperative patients who do not comply with the guidelines for oral glucose consumption. In a very small number of patients, the cause is not dietary indiscretions but, instead, factitious insulin administration or nesidioblastosis. The optimal evaluation and management for these diagnoses is not completely lucid yet important for bariatric surgeons and physicians alike to be familiar. Our objectives were to review the appropriate evaluation and treatment options for etiologies of hypoglycemia after gastric bypass and to create an algorithm that biochemically assesses the etiology of hypoglycemia. The setting was a university hospital in the United States. Methods: We present the cases of 3 patients who developed symptomatic hypoglycemia from distinct etiologies after laparoscopic Roux-en-Y gastric bypass. We also reviewed the current data regarding diagnosis and treatment. Results: Each patient's evaluation and management is elaborated in detail. We propose a novel algorithm for the biochemical evaluation of hypoglycemia after gastric bypass according to our experience and the review of the literature. Conclusion: Most cases of symptomatic hypoglycemia that develop in gastric bypass patients are associated with dietary indiscretions. However, a small subset of patients can develop refractory, recurrent, hyperinsulinemic hypoglycemia from factitious insulin administration or nesidioblastosis.

AB - Background: Gastric bypass is a proven treatment option for weight loss and the reduction of medical co-morbid conditions in the obese population. Severe refractory and/or recurrent hypoglycemia can occur, especially in postoperative patients who do not comply with the guidelines for oral glucose consumption. In a very small number of patients, the cause is not dietary indiscretions but, instead, factitious insulin administration or nesidioblastosis. The optimal evaluation and management for these diagnoses is not completely lucid yet important for bariatric surgeons and physicians alike to be familiar. Our objectives were to review the appropriate evaluation and treatment options for etiologies of hypoglycemia after gastric bypass and to create an algorithm that biochemically assesses the etiology of hypoglycemia. The setting was a university hospital in the United States. Methods: We present the cases of 3 patients who developed symptomatic hypoglycemia from distinct etiologies after laparoscopic Roux-en-Y gastric bypass. We also reviewed the current data regarding diagnosis and treatment. Results: Each patient's evaluation and management is elaborated in detail. We propose a novel algorithm for the biochemical evaluation of hypoglycemia after gastric bypass according to our experience and the review of the literature. Conclusion: Most cases of symptomatic hypoglycemia that develop in gastric bypass patients are associated with dietary indiscretions. However, a small subset of patients can develop refractory, recurrent, hyperinsulinemic hypoglycemia from factitious insulin administration or nesidioblastosis.

KW - Distal pancreatectomy

KW - Dumping syndrome

KW - Factitious insulin administration

KW - Gastric bypass

KW - Hyperinsulinemia

KW - Hypoglycemia

KW - Morbid obesity

KW - Nesidioblastosis

KW - Pancreaticoduodenectomy

UR - http://www.scopus.com/inward/record.url?scp=84866390252&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84866390252&partnerID=8YFLogxK

U2 - 10.1016/j.soard.2011.08.008

DO - 10.1016/j.soard.2011.08.008

M3 - Article

C2 - 21982939

AN - SCOPUS:84866390252

VL - 8

SP - 641

EP - 647

JO - Surgery for Obesity and Related Diseases

JF - Surgery for Obesity and Related Diseases

SN - 1550-7289

IS - 5

ER -