Hypoglycemia unawareness in a patient with dumping syndrome: report of a case.
We report the case of a 49-yr-old man affected by coma and hypoglycemia unawareness following repetitive hypoglycemic episodes due to dumping syndrome. The dumping syndrome, which was due to partial gastrectomy and vagotomy performed for recurrent peptic ulcer, was responsible for reactive hyperinsulinemia as demonstrated by an oral glucose tolerance test. While the glucose counterregulatory hormones were all normally sensitive to specific stimulation tests, insulin-induced hypoglycemia failed to induce an adequate counterregulatory response, causing no response in plasma norepinephrine, a slight and short increase in plasma cortisol, ACTH and glucagon and an insufficient increase in plasma epinephrine and GH. This case demonstrates that hypoglycemia unawareness has to be taken into account not only in patients affected by IDDM or insulinoma but also in any case of reactive hypoglycemia.
Dipartimento di Fisiopatologia Clinica, Università di Firenze, Italy.
F
F
Bellini
L
L
Sammicheli
L
L
Ianni
C
C
Pupilli
M
M
Serio
M
M
Mannelli
D000324:Adrenocorticotropic Hormone; D001786:Blood Glucose / Q000378:metabolism; D002096:C-Peptide / Q000097:blood; D003128:Coma / Q000209:etiology; D003346:Corticotropin-Releasing Hormone; D004377:Dumping Syndrome / Q000097:blood / Q000209:etiology / Q000503:physiopathology*; D005743:Gastrectomy / Q000009:adverse effects; D005951:Glucose Tolerance Test; D006728:Hormones / Q000097:blood; D006801:Humans; D007003:Hypoglycemia / Q000097:blood / Q000209:etiology / Q000503:physiopathology*; D007328:Insulin / Q000097:blood; D008297:Male; D008875:Middle Aged; D010465:Perception; D010901:Pituitary Function Tests; D014628:Vagotomy
D001786:Blood Glucose; D002096:C-Peptide; D006728:Hormones; D007328:Insulin; D000324:Adrenocorticotropic Hormone; D003346:Corticotropin-Releasing Hormone