title: Hyperinsulinemic Hypoglycemia after Bariatric Surgery: Diagnosis and Management Experience from a Spanish Multicenter Registry.
abstract: BACKGROUND
  Severe postprandial hypoglycemia after bariatric surgery is a rare but invalidating complication. Our aim was to describe the different tests performed for its diagnosis and their outcomes as well as the response to the prescribed pharmacological and surgical treatments.
  
  
  METHODS
  Multicenter, retrospective systematic review of cases with recurrent severe postprandial hypoglycemia.
  
  
  RESULTS
  Over 11 years of follow-up, 22 patients were identified. The test most used to provoke hypoglycemia was the oral glucose load test followed by the mixed meal test which was the least standardized test. With pharmacological treatment, 3 patients were symptom-free (with octreotide) and in 12 patients hypoglycemic episodes were attenuated. Seven patients had persistent hypoglycemic episodes and underwent surgery. Partial pancreatectomy was performed in 3 patients who had positive selective arterial calcium stimulation, and nesidioblastosis was confirmed in 2 patients. Reconversion to normal anatomy was performed in 3 patients, and 1 patient underwent a resection of the 'candy cane' roux limb, with resolution of hypoglycemia in all cases.
  
  
  CONCLUSIONS
  There is high heterogeneity in the evaluation and treatment options for postoperative hypoglycemia. In patients that do not respond to pharmacological treatment, reconstruction of gastrojejunal continuity may be the safest and most successful procedure.
authors.affiliation: Department of Endocrinology and Nutrition, Hospital Universitario de Bellvitge-IDIBELL, Lx00B4;Hospitalet de Llobregat, Barcelona, Spain.
authors.forename: Nuria
authors.initials: N
authors.lastname: Vilarrasa
authors.forename: Albert
authors.initials: A
authors.lastname: Goday
authors.forename: Miguel Angel
authors.initials: MA
authors.lastname: Rubio
authors.forename: Assumpta
authors.initials: A
authors.lastname: Caixàs
authors.forename: Silvia
authors.initials: S
authors.lastname: Pellitero
authors.forename: Andrea
authors.initials: A
authors.lastname: Ciudin
authors.forename: Alfonso
authors.initials: A
authors.lastname: Calañas
authors.forename: José Ignacio
authors.initials: JI
authors.lastname: Botella
authors.forename: Irene
authors.initials: I
authors.lastname: Bretón
authors.forename: María José
authors.initials: MJ
authors.lastname: Morales
authors.forename: María Jesús
authors.initials: MJ
authors.lastname: Díaz-Fernández
authors.forename: Pedro Pablo
authors.initials: PP
authors.lastname: García-Luna
authors.forename: Albert
authors.initials: A
authors.lastname: Lecube
mesh_terms: D000328:Adult; D050110:Bariatric Surgery / Q000009:adverse effects*; D005260:Female; D005951:Glucose Tolerance Test; D006801:Humans; D006946:Hyperinsulinism / Q000097:blood / Q000209:etiology*; D007003:Hypoglycemia / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology* / Q000628:therapy; D015994:Incidence; D007583:Jejunum / Q000601:surgery; D008297:Male; D008875:Middle Aged; D046768:Nesidioblastosis / Q000150:complications / Q000175:diagnosis / Q000453:epidemiology; D015282:Octreotide / Q000627:therapeutic use; D010180:Pancreatectomy; D012042:Registries; D012189:Retrospective Studies; D013030:Spain / Q000453:epidemiology; D013270:Stomach / Q000601:surgery
chemical_list: D015282:Octreotide