Hypoglycemia from delayed onset late dumping syndrome caused by subclinical adrenal insufficiency:a report of four patients

Abstract

[Background] Hypoglycemia is a symptom of late dumping syndrome (LDS). LDS is caused by the rapid jejunal influx of carbohydrates, a rapid rise in blood glucose level, excessive insulin secretion, and delayed suppression of excessive insulin secretion by altered physiological continuity of the upper gastrointestinal tract. It presumably manifests itself in the early period after gastrectomy. [Cases] We experienced four patients who each showed no physical signs of Addison’s disease, but who were referred to our hospital because of frequent hypoglycemia. Each patient had undergone gastrectomy several years previously. All patients experienced hypoglycemia with glucose levels less than 50 mg/dL within 60 minutes of a 75-gram modified glucose tolerance test. These findings were consistent with LDS. Low-dose adrenocorticotrophic releasing hormone stimulation tests revealed that cortisol peak levels were less than 20μg/dL in each case. We therefore diagnosed these patients with subclinical adrenal insufficiency. After administration of hydrocortisone, the hypoglycemia was resolved in each case. [Conclusions] LDS may manifest many years after gastrectomy because of the subclinical development of adrenal insufficiency.