title: Severe hypoglycemia after gastric bypass surgery for morbid obesity.
abstract: Recently, hypoglycemia with endogenous hyperinsulinemia has been described after undergoing bariatric surgery because of morbid obesity. It has been theorized that after a gastric bypass surgery, some trophic factors affecting pancreatic beta cells could emerge. The authors present a case of morbidly obese patient with severe hypoglycemia 3 months after bariatric surgery. An abdominal helicoidally computed tomography scan showed a 1.7 cm tumor in the tail of the pancreas. Histopathology revealed an insulinoma with well-defined contours surrounded by pancreatic tissue with atrophic signs and with hyperplasia and hypertrophic phenomena compatible with nesidioblastosis in adjacent islets of the pancreatic duct. Authors hypothesize that maintenance of the stimulus produces hyperplasia/hypertrophy of the pancreatic islets and reemphasizes the dynamic qualities of pancreatic beta cells and the possibility of producing hyperplasia from the extreme resistance to insulin present in morbidly obese patients.
authors.affiliation: Endocrinology and Nutrition Department, University Hospital La Fe, Valencia, Spain.
authors.forename: Pablo
authors.initials: P
authors.lastname: Abellán
authors.forename: Rosa
authors.initials: R
authors.lastname: Cámara
authors.forename: Juan Francisco
authors.initials: JF
authors.lastname: Merino-Torres
authors.forename: Antonia
authors.initials: A
authors.lastname: Pérez-Lazaro
authors.forename: María Isabel
authors.initials: MI
authors.lastname: del Olmo
authors.forename: José Luis
authors.initials: JL
authors.lastname: Ponce
authors.forename: José Miguel
authors.initials: JM
authors.lastname: Rayón
authors.forename: Francisco
authors.initials: F
authors.lastname: Piñón
mesh_terms: D015390:Gastric Bypass / Q000009:adverse effects*; D006801:Humans; D006965:Hyperplasia; D007003:Hypoglycemia / Q000209:etiology*; D050417:Insulin-Secreting Cells / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000601:surgery*; D010190:Pancreatic Neoplasms / Q000175:diagnosis*; D011183:Postoperative Complications / Q000175:diagnosis