Ketotic Hypoglycaemia Following Sleeve Gastrectomy.

IF 3 3区 医学 Q2 ENDOCRINOLOGY & METABOLISM
Jinwen He, Liza Phillips, Janelle Nisbet, Adam Morton
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引用次数: 0

Abstract

Post-bariatric surgery hypoglycaemia is typically mediated by hyperinsulinaemia, although the exact mechanisms are incompletely understood. Two cases of non-insulin mediated, ketotic hypoglycaemia following sleeve gastrectomy are presented. After fasting for 40 and 65 h, respectively, both patients developed symptomatic hypoglycaemia, with corresponding low insulin, low c-peptide and elevated beta-hydroxybutyrate levels. Morning cortisol and IGF1 levels were normal. Potential mechanisms for ketotic hypoglycaemia following bariatric surgery include reduction in hepatic, renal and intestinal gluconeogenesis, or alternatively an underlying inborn error of metabolism such as a glycogen storage disorder unmasked by bariatric surgery. Most glycogen storage disorders present in childhood, but there have been rare case reports of glycogen storage disorders types I, III and IX diagnosed in adulthood. Neither of the above cases had other features of a glycogen storage disorder such as elevated lactate, hyperuricaemia, hypertriglyceridaemia, hepatomegaly, myopathy or an indicative family history. Both patients trialled first-line dietary management, which was inadequate in managing hypoglycaemia. Treatment with the glucagon-like peptide-1 receptor agonist semaglutide resulted in the resolution of hypoglycaemic episodes in one patient, and a significant reduction in hypoglycaemic episodes in the other patient.

袖珍胃切除术后的酮症低血糖。
减肥手术后低血糖通常由高胰岛素血症介导,尽管其确切机制尚不完全清楚。本文报道2例非胰岛素介导的酮症性低血糖。禁食40和65 h后,两例患者均出现症状性低血糖,相应的胰岛素、c肽和β -羟基丁酸水平均较低。早晨皮质醇和IGF1水平正常。减肥手术后酮症性低血糖的潜在机制包括肝脏、肾脏和肠道糖异生的减少,或者是潜在的先天代谢错误,如减肥手术暴露的糖原储存障碍。大多数糖原储存障碍存在于儿童时期,但在成年期诊断出I型,III型和IX型糖原储存障碍的罕见病例报告。上述病例均无糖原储存障碍的其他特征,如乳酸升高、高尿酸血症、高甘油三酯血症、肝肿大、肌病或指示性家族史。这两名患者都接受了一线饮食管理,但这不足以控制低血糖。使用胰高血糖素样肽-1受体激动剂semaglutide治疗,1例患者的低血糖发作得到缓解,另1例患者的低血糖发作显著减少。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Clinical Endocrinology
Clinical Endocrinology 医学-内分泌学与代谢
CiteScore
6.40
自引率
3.10%
发文量
192
审稿时长
1 months
期刊介绍: Clinical Endocrinology publishes papers and reviews which focus on the clinical aspects of endocrinology, including the clinical application of molecular endocrinology. It does not publish papers relating directly to diabetes care and clinical management. It features reviews, original papers, commentaries, correspondence and Clinical Questions. Clinical Endocrinology is essential reading not only for those engaged in endocrinological research but also for those involved primarily in clinical practice.
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