title: Insulinoma After Bariatric Surgery: Diagnostic Dilemma and Therapeutic Approaches.
abstract: Hypoglycemia is increasingly recognized as a complication of bariatric surgery. Typically, hypoglycemia does not appear immediately postoperatively, but rather more than 1 year later, and usually occurs 1-3 h after meals. While rare, insulinoma has been reported after bariatric surgery. Clinical factors which should raise suspicion for insulinoma and the need for comprehensive clinical and biochemical evaluation include hypoglycemia occurring in the fasting state, predating bariatric surgery, and/or worsening immediately postoperatively, and lack of response to conservative therapy. Localization and successful resection of insulinoma can be achieved using novel endoscopic ultrasound and surgical approaches. In summary, hypoglycemia presenting shortly after gastric bypass or with a dominant fasting pattern should be fully evaluated to exclude insulinoma. Additionally, evaluation prior to gastric bypass should include screening for history of hypoglycemia symptoms.
authors: Research Division, Joslin Diabetes Center, 1 Joslin Place, Boston, MA, 02215, USA.|Clinic Division, Joslin Diabetes Center, 1 Joslin Place, Boston, MA, 02215, USA.|Division of Endocrinology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA.|Harvard Medical School, Boston, MA, USA.
authors: Christopher M
authors: CM
authors: Mulla
authors: Harvard Medical School, Boston, MA, USA.|Pancreas and Liver Institute, Beth Israel Deaconess Medical Center, Boston, MA, USA.|Department of Surgery, Beth Israel Deaconess Medical Center, Boston, MA, USA.
authors: Alessandra
authors: A
authors: Storino
authors: Harvard Medical School, Boston, MA, USA.|Department of Pathology, Beth Israel Deaconess Medical Center, Boston, MA, USA.
authors: Eric U
authors: EU
authors: Yee
authors: Harvard Medical School, Boston, MA, USA.|Department of Surgery, Emerson Hospital and Massachusetts General Hospital, Concord, MA, USA.
authors: David
authors: D
authors: Lautz
authors: Harvard Medical School, Boston, MA, USA.|Division of Gastroenterology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA.
authors: Mandeep S
authors: MS
authors: Sawnhey
authors: Harvard Medical School, Boston, MA, USA.|Pancreas and Liver Institute, Beth Israel Deaconess Medical Center, Boston, MA, USA.|Department of Surgery, Beth Israel Deaconess Medical Center, Boston, MA, USA.
authors: A James
authors: AJ
authors: Moser
authors: Research Division, Joslin Diabetes Center, 1 Joslin Place, Boston, MA, 02215, USA. mary.elizabeth.patti@joslin.harvard.edu.|Clinic Division, Joslin Diabetes Center, 1 Joslin Place, Boston, MA, 02215, USA. mary.elizabeth.patti@joslin.harvard.edu.|Division of Endocrinology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA. mary.elizabeth.patti@joslin.harvard.edu.|Harvard Medical School, Boston, MA, USA. mary.elizabeth.patti@joslin.harvard.edu.
authors: Mary-Elizabeth
authors: ME
authors: Patti
mesh_terms: D050110:Bariatric Surgery / Q000009:adverse effects; D006801:Humans; D007003:Hypoglycemia / Q000175:diagnosis / Q000209:etiology*; D007340:Insulinoma / Q000175:diagnosis*; D009767:Obesity, Morbid / Q000150:complications; D010190:Pancreatic Neoplasms / Q000175:diagnosis*; D011184:Postoperative Period
keywords: Bariatric surgery; Gastric bypass; Hypoglycemia; Insulinoma; Minimally invasive surgery