Use of a somatostatin analogue in treating severe hypoglycaemia and neuroglycopaenia, in association with hyperinsulinaemia, post bariatric surgery

摘要

Dumping syndrome is a well-recognised phenomenon post bariatric surgery. However, are all post-prandial symptoms in such patients simply a result of classical dumping? Our case clearly highlights that as clinicians we should be alert to the possibility of post-prandial hyperinsulinaemic hypoglycaemia leading to severe neuroglycopaenia.We describe a 51-year-old man presenting with symptoms of pallor, light-headedness, nausea, weakness and collapse, in association with low blood glucose, post-prandially.The patient had recorded random capillary blood glucose between 1.9-2.6mmol/L on a blood glucose meter during such episodes. His symptoms developed 12 months following gastric bypass surgery and 100kg weight loss. Initially, he was managed with dietary modification, but to no avail.The patient was subsequently admitted for inpatient investigation which excluded fasting hypoglycaemia and confirmed post-prandial hypoglycaemia with severe neuroglycopaenia. Hence a diagnosis of hyperinsulinaemic hypoglycaemia was made. He was commenced on octreotide 50ug three times daily and this treatment led to a significant reduction in the frequency and severity of his symptoms.We feel that this case highlights a problem that will be more frequently encountered as numbers of patients undergoing bariatric surgery increase. Clinicians need to be vigilant to the possibility of this diagnosis and treat appropriately to avoid significant morbidity.