Outcomes and quality of life after partial pancreatectomy for noninsulinoma pancreatogenous hypoglycemia from diffuse islet cell disease

Abstract

Background Noninsulinoma pancreatogenous hypoglycemia (NIPH) is a rare cause of hypoglycemia from excessive insulin secretion, especially affecting post-bariatric surgery patients. Partial pancreatectomy may control hypoglycemia; however, multiple patients experienced symptomatic relapse. Our study goal was to assess frequency and severity of recurrent symptoms postoperatively. Methods Demographics, preoperative testing, operative and postoperative details were reviewed for all patients who underwent pancreatic resection for NIPH at Mayo Clinic from January 1996 - December 2008. Patient records and mail surveys (including European Quality of Life Survey (EQ-5D) and Fear of Hypoglycemia Scale (FOHS-98)) were used to assess outcome. Results 75 patients underwent pancreatic resection for NIPH. 48 patients (70%) completed the survey (median follow-up 53 mo.). Median time to recurrent symptoms was 16 months (N=41, 87%). Despite symptom recurrence, 75% of patients reported overall improvement in quality of life, with marked reduction in psychological stress and hypoglycemic symptoms (greater than 50% decrease in FOHS-98 scores (p<0.001). Overall, half of the patients were classified as highly/moderately surgically-successful. Nevertheless, 25% of patients experienced no apparent benefit. Conclusions Although nearly 90% of NIPH patients reported recurrent symptoms suggestive of hypoglycemia, a majority reported significant improvements in QOL and marked reduction in other symptoms after pancreatic resection.

Impact of variant pancreatic arterial anatomy and overlap in regional perfusion on the interpretation of selective arterial calcium stimulation with hepatic venous sampling for preoperative localization of occult insulinoma

“…28 NIPHS patients may be offered partial pancreatectomy to reduce their beta islet cell mass and hypoglycemic symptoms. 33 Interestingly, there were four patients with surgically confirmed insulinoma in the present cohort who developed postprandial hyperinsulinemic hypoglycemia after Roux-en-Y gastric-bypass surgery. As such, both nesidioblastosis and insulinoma need to be considered in the differential in patients with a history of Roux-en-Y gastric-bypass surgery undergoing SACST, as illustrated by the case of the patient with a history of gastric bypass surgery and a positive but non-localizing SACST described above.…”

Hypoglycemia after Roux-En-Y gastric bypass: detection rates of continuous glucose monitoring (CGM) versus mixed meal test

“…A much larger number of patients might suffer from vague symptoms and are therefore not being diagnosed with post-gastric bypass hypoglycemia. Subsequently, they are not offered adequate treatment, which might consist of dietary modifications [18,28], acarbose [29][30][31], octreotide [15,32], verapamil [33] or diazoxide [34] as drug therapy or surgical interventions such as secondary bypass banding [35,36], bypass reversal [37,38] or pancreatic resection [24][25][26][27]39]. In our study, CGM provided better detection rates for post-RYGB hypoglycemia compared with MMT.…”

Insulinoma or non-insulinoma pancreatogenous hypoglycemia? A diagnostic dilemma

“…The majority of cases reported in adults occur following bariatric surgery and are thought to be secondary to elevated glucagon-like peptide-1 causing pancreatic islet cell hyperplasia [3–5]. Postprandial hyperinsulinemic hypoglycemia, negative 72-h fasts, negative preoperative localization studies for insulinoma and positive selective arterial calcium infusion tests together are suggestive; however, differentiating insulinoma and NIPH preoperatively remains challenging and ultimately requires histologic assessment.…”