Functional Imaging in Hyperinsulinemic Hypoglycemia after Gastric Bypass Surgery for Morbid Obesity

Loek J. M. de Heide, Andor W. J. M. Glaudemans, Peter H. N. Oomen, Jan A. Apers, Eric R. E. Totte, Andre P. van Beek*

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

22 Citations (Scopus)

Abstract

Context: Hyperinsulinemic hypoglycemia after Roux-en-Y gastric bypass (RYGB) has been increasingly reported. It is induced by beta-cell hyperplasia often referred to as nesidioblastosis. Positron emission tomography (PET) with [11C]-5-hydroxytryptophan (C-11-HTP) and 6-[18F]fluoro-3,4-dihydroxy-L-phenylalanine (F-18-DOPA) has been successfully applied to image neuroendocrine tumors. No data are available of the usefulness of these functional imaging techniques in post-RYGB in this new endocrine disorder, neither for diagnostic purposes nor for follow-up.

Objective: We present a patient with post-RYGB hypoglycemia who underwent C-11-HTP and F-18-DOPA PET scintigraphy for diagnostic purposes and to evaluate the effect of additional laparoscopic adjustable banding of the pouch as a surgical therapy for this disorder.

Patient: We describe a woman with biochemically confirmed post-RYGB hypoglycemia who showed diffuse uptake of the C-11-HTP and F-18-DOPA tracers in the entire pancreas. After failure of dietary and medical treatment options, she underwent a laparoscopic adjustable banding for pouch dilatation. Subjective improvement was noted, which coincided with decreased uptake of F-18-DOPA and C-11-HTP in the head of the pancreas.

Conclusions: Functional imaging by F-18-DOPA- and C-11-HTP-PET can accurately visualize diffuse endocrine pancreatic activity in post-gastric bypass hyperinsulinemic hypoglycemia. Both C-11-HTP- and F-18-DOPA-PET imaging appear to have a similar diagnostic performance in the presented case, and uptake of both tracers potentially relates to disease activity after surgical intervention. (J Clin Endocrinol Metab 97: E963-E967, 2012)

Original languageEnglish
Pages (from-to)E963-E967
Number of pages5
JournalJournal of Clinical Endocrinology and Metabolism
Volume97
Issue number6
DOIs
Publication statusPublished - Jun-2012

Keywords

  • POSITRON-EMISSION-TOMOGRAPHY
  • BETA-CELL HYPERPLASIA
  • INSULIN-SECRETION
  • CONGENITAL HYPERINSULINISM
  • INFANCY
  • HUMANS
  • TUMORS
  • PET

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