title: Delayed Imaging Presentation of a Symptomatic Insulinoma After Bariatric Surgery.
abstract: Many reports exist on hyperinsulinemic hypoglycemia after bariatric surgery, which can result in persistence of the metabolic syndrome in patients who have undergone these procedures. While the noninsulinoma pancreatogenous hypoglycemia syndrome, or nesidioblastosis, has garnered increased attention in these patients, its presentation is similar to patients with an insulinoma and this entity must therefore be evaluated and ruled out. Herein, we present a patient who developed symptoms of hypoglycemia 7 years after Roux-en-Y gastric bypass surgery. While a diagnosis of insulinoma was entertained, his laboratory values were indeterminate and imaging localization was inconclusive. Because of significant medical comorbidities, he was managed symptomatically until imaging ultimately localized a lesion in the pancreatic uncinate process consistent with an insulinoma. He subsequently underwent resection and remains disease and symptom free 1 year after surgery. This case demonstrates the diagnostic and imaging dilemma in patients with hypoglycemia after bariatric surgery and should be of interest to anyone who cares for these patients.
authors: Department of Medicine, Division of Hematology-Oncology, North Florida/South Georgia Veterans Health System and the University of Florida College of Medicine, Gainesville, FL, USA.
authors: Jennifer M
authors: JM
authors: Duff
authors: Department of Medicine, Division of Endocrinology & Metabolism, North Florida/South Georgia Veterans Health System and the University of Florida College of Medicine, Gainesville, FL, USA.
authors: Hans K
authors: HK
authors: Ghayee
authors: Department of Pathology, North Florida/South Georgia Veterans Health System, Gainesville, FL, USA.
authors: Michelle
authors: M
authors: Weber
authors: Department of Surgery, North Florida/South Georgia Veterans Health System and the University of Florida College of Medicine, Gainesville, FL, USA. Ryan.Thomas@surgery.ufl.edu.
authors: Ryan M
authors: RM
authors: Thomas
mesh_terms: D000368:Aged; D015390:Gastric Bypass / Q000009:adverse effects*; D006801:Humans; D007003:Hypoglycemia / Q000000981:diagnostic imaging* / Q000209:etiology; D007340:Insulinoma / Q000000981:diagnostic imaging* / Q000209:etiology* / Q000473:pathology; D008297:Male; D009767:Obesity, Morbid / Q000601:surgery; D010190:Pancreatic Neoplasms / Q000000981:diagnostic imaging* / Q000209:etiology* / Q000473:pathology; D014057:Tomography, X-Ray Computed
keywords: Bariatric surgery; Insulinoma; Noninsulinoma pancreatogenous hypoglycemia syndrome; Pancreatic neuroendocrine tumor