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The Metabolic Medicine Postoperative Bariatric Surgery Consultation
Published in Michael M. Rothkopf, Jennifer C. Johnson, Optimizing Metabolic Status for the Hospitalized Patient, 2023
Michael M. Rothkopf, Jennifer C. Johnson
On the other hand, hypoglycemia can occur as part of the dumping syndrome. Further, a more severe form of hypoglycemia, with neuroglycopenic symptoms, has developed in some diabetic and pre-diabetic postbariatric patients. It occurs with the combination of excess insulin production in a patient who is becoming less insulin resistant (through weight loss). This syndrome has been labeled nesidioblastosis by Service et al. (2005). It can cause life-threatening hypoglycemic episodes, which require medical management or even partial pancreatectomy to resolve.
The adrenal glands and other abdominal endocrine disorders
Published in Professor Sir Norman Williams, Professor P. Ronan O’Connell, Professor Andrew W. McCaskie, Bailey & Love's Short Practice of Surgery, 2018
Professor Sir Norman Williams, Professor P. Ronan O’Connell, Professor Andrew W. McCaskie
The differential diagnosis of hypoglycaemia includes hormonal deficiencies, hepatic insufficiency, medication, drugs and enzyme defects. Occasionally, differentiating insulinoma from other causes of hypoglycaemia can be difficult. Nesidioblastosis is a rare disorder, mainly encountered in children, which is characterised by replacement of normal pancreatic islets by diffuse hyperplasia of islet cells.
Congenital hyperinsulinism
Published in Demetrius Pertsemlidis, William B. Inabnet III, Michel Gagner, Endocrine Surgery, 2017
Christopher A. Behr, Stephen E. Dolgin
Hypoglycemia is especially dangerous to the developing brain of the newborn. While most causes of neonatal hypoglycemia are transient, those that persist can have devastating consequences. Therefore, it is of the utmost importance to identify, categorize, and appropriately treat these patients as promptly as possible. Most cases of persistent hypoglycemia seen in neonates are due to the overproduction of insulin. This condition was previously termed nesidioblastosis, and was thought to be due to diffuse hyperplasia of pancreatic islet cells. As we have learned more about the disease complex, this term is inaccurate. A more comprehensive and generally accepted term is congenital hyperinsulinism (CH). Insulinomas are a separate entity and are quite rare in childhood. They are not thought to be congenital and will not be addressed in this chapter [1]. Although CH may present throughout childhood and rarely even in adulthood, the most common age is within the neonatal period or infancy. The early-presenting cases invariably end up being more severe, more resistant to medical management, and more likely to require surgical intervention. Therefore, this chapter concentrates on CH specifically in the newborn patient, and highlights recent developments in genetics, diagnostic modalities, and surgical techniques that have improved the way clinicians manage this disease.
Evidence of unrestrained beta-cell proliferation and neogenesis in a patient with hyperinsulinemic hypoglycemia after gastric bypass surgery
Published in Islets, 2018
Nidheesh Dadheech, Dominique Garrel, Jean Buteau
We herein describe a patient who developed HIHG after gastric bypass. Pancreatic sections presented both unrestrained beta-cell proliferation and histological evidence of beta-cell neogenesis from ductal progenitor cells, compared to tissue samples from weight-matched donors. This latter conclusion is born out by our detection of i) small cluster of insulin-positive cells abutting ducts, ii) bi-hormonal-positive cells in the duct epithelium and iii) the expression of nestin, an early endocrine progenitor marker expressed during pancreatic morphogenesis but generally absent in the adult pancreas.20 These findings are consistent with the histopathologic definition of “nesidioblastosis”.21 The term was first coined to describe persistent hyperinsulinemic hypoglycemia of infancy (PHHI), a pathology also characterized by abnormal islet mass expansion and islet neogenesis,22 but was more recently used to encompass HIHG after gastric bypass as well. A limitation to our study is that it is limited to a single patient but we expect that further advances will be made possible as more tissues become available from the increasing number of persons with extreme obesity undergoing bariatric surgical procedures.
Imaging of pancreatic neuroendocrine tumors: recent advances, current status, and controversies
Published in Expert Review of Anticancer Therapy, 2018
Lingaku Lee, Tetsuhide Ito, Robert T. Jensen
Assessment of insulin gradients continues to be used in a number of centers for patients with insulinomas with negative imaging by other modalities [33,35–38]. At present this is performed in almost all cases by the selective intra-arterial injection of calcium with sampling for insulin concentrations from hepatic veins [33,35–38]. This method has high sensitivity varying from 72 to 100%, with most studies reporting a sentivity of 88–100% [32,35–37]. In the diagnosis of endogenous hyperinsulinemic hypoglycemia, it is important to differentiate insulinoma from the noninsulinoma pancreatogenous hypoglycemia syndrome (NIPHS), which is due to nesidioblastosis, as they are treated differently [38,223,232]. Unfortunately, the cross-sectional imaging may be negative in both, 68Ga-DOTA-SSA PET/CT can give a false positive result in NIPHS suggesting insulinoma, and the selective calcium infusion with insulin gradients can be positive in both [38,232,233]. In a recent study [38], the results of the selective arterial calcium study with hepatic venous sampling for insulin (SACST) was reported to differentiate these two conditions using two criteria [a maximum increase in hepatic venous insulin concentration > 91.5 or > 263.5 ulU/mL] with 95% and 100% specificity, respectively.
Diazoxide during pregnancy and lactation: drug levels in maternal serum, cord blood, breast milk, and infant serum: a case report
Published in Gynecological Endocrinology, 2022
Jumpei Saito, Hiroyo Kawasaki, Natsuho Adachi, Aiko Sasaki, Naho Yakuwa, Tomo Suzuki, Haruhiko Sago, Akimasa Yamatani, Reiko Horikawa, Atsuko Murashima
Nesidioblastosis is a common cause of congenital hyperinsulinemic hypoglycemia [1]. It is defined as non-neoplastic proliferation of both islet and ductular cells and formation of ductuloinsular complexes, which are characterized by islet cell hyperplasia arising from proliferating ductal epithelium [2]. Women with severe hypoglycemia are at increased risk for postpartum hemorrhage and infection, as well as hemolysis, elevated liver enzymes, and low platelet (HELLP) syndrome [3]. Thus, close medical monitoring should be required for pregnant women with hypoglycemia. Maternal hypoglycemia during pregnancy is associated with intrauterine growth retardation and pre-eclampsia [4,5].