HYPOGLYCEMIA UNAWARENESS IN A PATIENT WITH DUMPING SYNDROME - REPORT OF A CASE

We report the case of a 49-yr-old man affected by coma and hypoglycemi a unawareness following repetitive hypoglycemic episodes due to dumpin g syndrome. The dumping syndrome, which was due to partial gastrectomy and vagotomy performed for recurrent peptic ulcer, was responsible fo r reactive hyperinsulinemia as demonstrated by an oral glucose toleran ce test. While the glucose counterregulatory hormones were ail normall y sensitive to specific stimulation tests, insulin-induced hypoglycemi a failed to induce an adequate counterregulatory response, causing no response in plasma norepinephrine, a slight and short increase in plas ma cortisol, ACTH and glucagon and an insufficient increase in plasma epinephrine and GH. This case demonstrates that hypoglycemia unawarene ss has to be taken into account not only in patients affected by IDDM or insulinoma but also in any case of reactive hypoglycemia. (J. Endoc rinol. Invest. 21: 463-467, 1998) (C) 1998, Editrice Kurtis.