Adrenal Insufficiency As a Contributor to Severe Hypoglycemia in Late Dumping Syndrome: A Case Series

Overview

Journal Cureus

Specialty Biomedical Engineering

Date 2025 Jan 6

PMID 39759743

Authors

Ken Kanazawa

Takeki Ito

Mai Hijikata

Koichiro Kuwabara

Affiliations

Soon will be listed here.

Abstract

Severe hypoglycemia (SH) is a significant risk, particularly in the elderly, and adrenal insufficiency (AI) may be a contributing factor. This study examines six cases of late dumping syndrome (LDS)-induced reactive hypoglycemia (RH), with AI as a potential trigger. Three of the six patients were diagnosed with AI, and one experienced a hypoglycemic coma. A significant correlation between blood glucose and insulin levels was found in the AI group. These findings suggest the potential role of AI in the development of SH in LDS patients after gastrectomy. Further research is needed for confirmation.

References

Hsu P, Sung S, Cheng H, Yeh J, Liu W, Chan W . Association of clinical symptomatic hypoglycemia with cardiovascular events and total mortality in type 2 diabetes: a nationwide population-based study. Diabetes Care. 2012; 36(4):894-900. PMC: 3609481. DOI: 10.2337/dc12-0916. View

Vecht J, Masclee A, Lamers C . The dumping syndrome. Current insights into pathophysiology, diagnosis and treatment. Scand J Gastroenterol Suppl. 1997; 223:21-7. View

Watanabe T, Ozawa A, Ishii S, Tomaru T, Shibusawa N, Saito T . Usage of continuous glucose monitoring (CGM) for detecting an unrecognized hypoglycemia and management of glucocorticoid replacement therapy in adult patients with central hypoadrenalism. Endocr J. 2018; 65(5):547-556. DOI: 10.1507/endocrj.EJ16-0387. View

Chin S, Rhee S, Chon S, Baik S, Park Y, Nam M . Hypoglycemia is associated with dementia in elderly patients with type 2 diabetes mellitus: An analysis based on the Korea National Diabetes Program Cohort. Diabetes Res Clin Pract. 2016; 122:54-61. DOI: 10.1016/j.diabres.2016.09.027. View

McLarty A, Deschamps C, Trastek V, Allen M, Pairolero P, Harmsen W . Esophageal resection for cancer of the esophagus: long-term function and quality of life. Ann Thorac Surg. 1997; 63(6):1568-72. DOI: 10.1016/s0003-4975(97)00125-2. View

Eloy R, Garaud J, Moody A, Jaeck D, GRENIER J . Jejunal factor stimulating insulin release in the isolated perfused canine pancreas and jejunum. Horm Metab Res. 1975; 7(6):461-7. DOI: 10.1055/s-0028-1093704. View

Ten S, New M, Maclaren N . Clinical review 130: Addison's disease 2001. J Clin Endocrinol Metab. 2001; 86(7):2909-22. DOI: 10.1210/jcem.86.7.7636. View

Bornstein S, Allolio B, Arlt W, Barthel A, Don-Wauchope A, Hammer G . Diagnosis and Treatment of Primary Adrenal Insufficiency: An Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab. 2016; 101(2):364-89. PMC: 4880116. DOI: 10.1210/jc.2015-1710. View

Tanenberg R, Newton C, Drake A . Confirmation of hypoglycemia in the "dead-in-bed" syndrome, as captured by a retrospective continuous glucose monitoring system. Endocr Pract. 2009; 16(2):244-8. DOI: 10.4158/EP09260.CR. View

10.

Service G, Thompson G, Service F, Andrews J, Collazo-Clavell M, Lloyd R . Hyperinsulinemic hypoglycemia with nesidioblastosis after gastric-bypass surgery. N Engl J Med. 2005; 353(3):249-54. DOI: 10.1056/NEJMoa043690. View

11.

Yaffe K, Falvey C, Hamilton N, Harris T, Simonsick E, Strotmeyer E . Association between hypoglycemia and dementia in a biracial cohort of older adults with diabetes mellitus. JAMA Intern Med. 2013; 173(14):1300-6. PMC: 4041621. DOI: 10.1001/jamainternmed.2013.6176. View

12.

Tack J, Arts J, Caenepeel P, De Wulf D, Bisschops R . Pathophysiology, diagnosis and management of postoperative dumping syndrome. Nat Rev Gastroenterol Hepatol. 2009; 6(10):583-90. DOI: 10.1038/nrgastro.2009.148. View

13.

Kato K, Kageyama S, Nakashima K, Ito H, Ito Y, Miyake T . End-stage Renal Disease in Which Diazoxide Was Effective in Treating Hypoglycemia Caused by Late Dumping Syndrome after Gastrectomy. Intern Med. 2023; 63(10):1421-1427. PMC: 11157299. DOI: 10.2169/internalmedicine.1704-23. View

14.

Meier J, Butler A, Galasso R, Butler P . Hyperinsulinemic hypoglycemia after gastric bypass surgery is not accompanied by islet hyperplasia or increased beta-cell turnover. Diabetes Care. 2006; 29(7):1554-9. DOI: 10.2337/dc06-0392. View

15.

Allen K, Frier B . Nocturnal hypoglycemia: clinical manifestations and therapeutic strategies toward prevention. Endocr Pract. 2004; 9(6):530-43. DOI: 10.4158/EP.9.6.530. View

16.

Yanase T, Tajima T, Katabami T, Iwasaki Y, Tanahashi Y, Sugawara A . Diagnosis and treatment of adrenal insufficiency including adrenal crisis: a Japan Endocrine Society clinical practice guideline [Opinion]. Endocr J. 2016; 63(9):765-784. DOI: 10.1507/endocrj.EJ16-0242. View