A Clinical Case of Insulinoma Presenting with Postprandial Hypoglycemia in a Patient with a History of Gastric Bypass Surgery
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 select...
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| Veröffentlicht in: | Internal Medicine 2022/04/15, Vol.61(8), pp.1189-1195 |
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| creator | Hayashida, Ryosuke Tsuchiya, Kyoichiro Sekine, Tetsuo Momose, Takashi Sato, Fuminori Sakurada, Maya Nishida, Kenji Hayashi, Tatsuya Morita, Yasuhiro Okada, Haruka Fukushima, Noriyoshi Yamada, Tetsuya Tsujino, Motoyoshi |
| description | 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. |
| doi_str_mv | 10.2169/internalmedicine.7428-21 |
| format | Article |
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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.</description><identifier>ISSN: 0918-2918</identifier><identifier>EISSN: 1349-7235</identifier><identifier>DOI: 10.2169/internalmedicine.7428-21</identifier><identifier>PMID: 34645754</identifier><language>eng</language><publisher>Japan: The Japanese Society of Internal Medicine</publisher><subject>Case Report ; Computed tomography ; Gastrectomy ; Gastric bypass ; Gastrointestinal surgery ; Hyperinsulinemia ; Hypoglycemia ; Insulin ; Insulinoma ; Internal medicine ; Pancreas ; Patients ; Spleen ; Splenectomy ; Splenic artery ; Surgery</subject><ispartof>Internal Medicine, 2022/04/15, Vol.61(8), pp.1189-1195</ispartof><rights>2022 by The Japanese Society of Internal Medicine</rights><rights>Copyright Japan Science and Technology Agency 2022</rights><rights>Copyright © 2022 by The Japanese Society of Internal Medicine</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c554t-42da77c6ebc7aa02a3a263657de9c7f28751ac8b291df0bdb780774c0623a9053</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC9107972/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC9107972/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,727,780,784,885,1883,27924,27925,53791,53793</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/34645754$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Hayashida, Ryosuke</creatorcontrib><creatorcontrib>Tsuchiya, Kyoichiro</creatorcontrib><creatorcontrib>Sekine, Tetsuo</creatorcontrib><creatorcontrib>Momose, Takashi</creatorcontrib><creatorcontrib>Sato, Fuminori</creatorcontrib><creatorcontrib>Sakurada, Maya</creatorcontrib><creatorcontrib>Nishida, Kenji</creatorcontrib><creatorcontrib>Hayashi, Tatsuya</creatorcontrib><creatorcontrib>Morita, Yasuhiro</creatorcontrib><creatorcontrib>Okada, Haruka</creatorcontrib><creatorcontrib>Fukushima, Noriyoshi</creatorcontrib><creatorcontrib>Yamada, Tetsuya</creatorcontrib><creatorcontrib>Tsujino, Motoyoshi</creatorcontrib><title>A Clinical Case of Insulinoma Presenting with Postprandial Hypoglycemia in a Patient with a History of Gastric Bypass Surgery</title><title>Internal Medicine</title><addtitle>Intern. Med.</addtitle><description>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.</description><subject>Case Report</subject><subject>Computed tomography</subject><subject>Gastrectomy</subject><subject>Gastric bypass</subject><subject>Gastrointestinal surgery</subject><subject>Hyperinsulinemia</subject><subject>Hypoglycemia</subject><subject>Insulin</subject><subject>Insulinoma</subject><subject>Internal medicine</subject><subject>Pancreas</subject><subject>Patients</subject><subject>Spleen</subject><subject>Splenectomy</subject><subject>Splenic artery</subject><subject>Surgery</subject><issn>0918-2918</issn><issn>1349-7235</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2022</creationdate><recordtype>article</recordtype><recordid>eNplkU1v1DAQhi0EosvCX0CWuHBJsZ0PxxeksoJupQoqAWdr4jhZrxJ7sZ2iHPjvONpl1ZbLWJp55vXMvAhhSi4ZrcQHY6P2FoZRt0YZqy95weqM0WdoRfNCZJzl5XO0IoKmbAoX6FUIe0Lymgv2El3kRVWUvCxW6M8V3gzGGgUD3kDQ2HX4xoYp5dwI-M7roG00tse_TdzhOxfiwYNtTeK388H1w6z0aAAbixMO0ST8yALemhCdnxfNawjRG4U_zQcIAX-ffK_9_Bq96GAI-s3pXaOfXz7_2Gyz22_XN5ur20yVZRGzgrXAuap0ozgAYZADq_Kq5K0Wines5iUFVTdp1bYjTdvwmnBeKFKxHAQp8zX6eNQ9TE26mUozehjkwZsR_CwdGPm4Ys1O9u5eCkq4SNdco_cnAe9-TTpEOZqg9DCA1W4KkpU1o0QwUSX03RN076bFrERVCUsIJYmqj5TyLgSvu_MwlMjFY_nUY7l4nEqp9e3DZc6N_0xNwNcjsA8Ren0GwEejBv2_ckVlvYTTD2dQ7cBLbfO_aPPHUw</recordid><startdate>20220415</startdate><enddate>20220415</enddate><creator>Hayashida, Ryosuke</creator><creator>Tsuchiya, Kyoichiro</creator><creator>Sekine, Tetsuo</creator><creator>Momose, Takashi</creator><creator>Sato, Fuminori</creator><creator>Sakurada, Maya</creator><creator>Nishida, Kenji</creator><creator>Hayashi, Tatsuya</creator><creator>Morita, Yasuhiro</creator><creator>Okada, Haruka</creator><creator>Fukushima, Noriyoshi</creator><creator>Yamada, Tetsuya</creator><creator>Tsujino, Motoyoshi</creator><general>The Japanese Society of Internal Medicine</general><general>Japan Science and Technology Agency</general><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7T5</scope><scope>7TK</scope><scope>7U9</scope><scope>H94</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>20220415</creationdate><title>A Clinical Case of Insulinoma Presenting with Postprandial Hypoglycemia in a Patient with a History of Gastric Bypass Surgery</title><author>Hayashida, Ryosuke ; Tsuchiya, Kyoichiro ; Sekine, Tetsuo ; Momose, Takashi ; Sato, Fuminori ; Sakurada, Maya ; Nishida, Kenji ; Hayashi, Tatsuya ; Morita, Yasuhiro ; Okada, Haruka ; Fukushima, Noriyoshi ; Yamada, Tetsuya ; Tsujino, Motoyoshi</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c554t-42da77c6ebc7aa02a3a263657de9c7f28751ac8b291df0bdb780774c0623a9053</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2022</creationdate><topic>Case Report</topic><topic>Computed tomography</topic><topic>Gastrectomy</topic><topic>Gastric bypass</topic><topic>Gastrointestinal surgery</topic><topic>Hyperinsulinemia</topic><topic>Hypoglycemia</topic><topic>Insulin</topic><topic>Insulinoma</topic><topic>Internal medicine</topic><topic>Pancreas</topic><topic>Patients</topic><topic>Spleen</topic><topic>Splenectomy</topic><topic>Splenic artery</topic><topic>Surgery</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Hayashida, Ryosuke</creatorcontrib><creatorcontrib>Tsuchiya, Kyoichiro</creatorcontrib><creatorcontrib>Sekine, Tetsuo</creatorcontrib><creatorcontrib>Momose, Takashi</creatorcontrib><creatorcontrib>Sato, Fuminori</creatorcontrib><creatorcontrib>Sakurada, Maya</creatorcontrib><creatorcontrib>Nishida, Kenji</creatorcontrib><creatorcontrib>Hayashi, Tatsuya</creatorcontrib><creatorcontrib>Morita, Yasuhiro</creatorcontrib><creatorcontrib>Okada, Haruka</creatorcontrib><creatorcontrib>Fukushima, Noriyoshi</creatorcontrib><creatorcontrib>Yamada, Tetsuya</creatorcontrib><creatorcontrib>Tsujino, Motoyoshi</creatorcontrib><collection>PubMed</collection><collection>CrossRef</collection><collection>Immunology Abstracts</collection><collection>Neurosciences Abstracts</collection><collection>Virology and AIDS Abstracts</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Internal Medicine</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Hayashida, Ryosuke</au><au>Tsuchiya, Kyoichiro</au><au>Sekine, Tetsuo</au><au>Momose, Takashi</au><au>Sato, Fuminori</au><au>Sakurada, Maya</au><au>Nishida, Kenji</au><au>Hayashi, Tatsuya</au><au>Morita, Yasuhiro</au><au>Okada, Haruka</au><au>Fukushima, Noriyoshi</au><au>Yamada, Tetsuya</au><au>Tsujino, Motoyoshi</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>A Clinical Case of Insulinoma Presenting with Postprandial Hypoglycemia in a Patient with a History of Gastric Bypass Surgery</atitle><jtitle>Internal Medicine</jtitle><addtitle>Intern. Med.</addtitle><date>2022-04-15</date><risdate>2022</risdate><volume>61</volume><issue>8</issue><spage>1189</spage><epage>1195</epage><pages>1189-1195</pages><artnum>7428-21</artnum><issn>0918-2918</issn><eissn>1349-7235</eissn><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. 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| subjects | Case Report Computed tomography Gastrectomy Gastric bypass Gastrointestinal surgery Hyperinsulinemia Hypoglycemia Insulin Insulinoma Internal medicine Pancreas Patients Spleen Splenectomy Splenic artery Surgery |
| title | A Clinical Case of Insulinoma Presenting with Postprandial Hypoglycemia in a Patient with a History of Gastric Bypass Surgery |
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