Insulinoma after sleeve gastrectomy:A case report  

作　　者：Miry Lobaton-Ginsberg Pilar Sotelo-González Claudia Ramirez-Renteria Fany Gabriela Juárez-Aguilar Aldo Ferreira-Hermosillo 

机构地区：[1]Facultad de Medicina,Universidad Anáhuac México Norte,Mexico City 52786,Mexico [2]Servicio de Endocrinología,Hospital de Especialidades,Centro Médico Nacional Siglo XXI,IMSS,Mexico City 06720,Mexico [3]Unidad de Investigación Médica en Enfermedades Endocrinas,Instituto Mexicano del Seguro Social,Mexico City 06720,Mexico [4]Servicio de Anatomía Patológica,Hospital de Especialidades del Centro Médico Nacional Siglo XXI,IMSS,Mexico City 06720,Mexico

出　　处：《World Journal of Clinical Cases》2022年第18期6227-6233,共7页世界临床病例杂志

摘　　要：BACKGROUND Laparoscopic sleeve gastrectomy(LSG)has been proposed as an effective and durable treatment for severe obesity and glucose metabolism disorders,and its prevalence has increased from 5%to 37%since 2008.One common complication after bariatric surgery is a postprandial hyperinsulinemic hypoglycemic state.While rare,insulinomas can cause this state,where symptoms are more common in the fasting state;thus,evaluation of insulin secretion is needed.Until now,there have been no reports of insulinoma after LSG.CASE SUMMARY We describe the case of a 43-year-old woman who was referred to the obesity clinic 2 years after LSG was performed.She had symptoms of hypoglycemia predominantly in the fasting state and documented hypoglycemia of less than 30 mg/d L,which are compatible with Whipple’s triad.Initially,dumping syndrome was suspected,but after a second low fasting plasma glucose was documented,a 72-h fasting test was performed that tested positive.Computed tomography and endoscopic ultrasound were performed,identifying the presence of a homogeneous hypoechoic semioval tumoral lesion in the pancreas.The diagnosis was compatible with insulinoma.After laparoscopic enucleation of the insulinoma,the symptoms and hypoglycemia disappeared.The histopathological report described a well-differentiated grade 2 neuroendocrine tumor with positive chromogranin and synaptophysin and Ki67 immunopositivity in 4%of the neoplastic cells.CONCLUSION Insulinoma after LSG is a rare condition,and clinicians must be aware of it,especially if the patient has hypoglycemic symptoms during the fasting state.

关 键 词：INSULINOMA HYPOGLYCEMIA Bariatric surgery Glucagon-like peptide 1 amide Neuroendocrine tumors Case report 

分 类 号：R736.7[医药卫生—肿瘤]