PATHOGENESIS OF HYPOGLYCEMIA IN CHILDHOOD DUMPING SYNDROME

Abstract

Reports of pediatric patients with dumping syndrome (DS) are few and the mechanisms of disturbed glucose homeostasis have not been studied. We evaluated 3 children presenting with severe hypoglycemic reactions secondary to DS; Pt 1 developed DS after fundoplication at 30 mo of age. Pt 2 diagnosed at 4 mo of age, had central hypoventilation, Hirschsprung's Disease, and generalized autonomic dysfunction. Pt 3 was 6 mo old when diagnosed and developed DS from malplacement of a feeding gastrostomy tube. Blood glucose levels during and after 2-5 meals in each child showed hyperglyceraia-375±97 mg% (m±SD) 30 min post-prandially and hypoglycemia-35±10 mg% >120 min later. Swings in glucose were proportional to volume of meals. Insulin and glucagon levels were followed during a single meal challenge test during which glucose rose to 356±59 mg% 30 min postprandially and fell to 32±11 mg% at 150±30 min. Hormonal analyses indicated (1) inappropriate early release of glucagon(300 pg/ml @ 15 min) in Pt 1, (2) exuberant early release of insulin (max 190±15 uU/ml) resulting in rapid fall in glucose in all patients, (3) prolonged cellular glucose uptake in the absence of circulating insulin leading to hypoglycemia in Pt 2, and (4) inadequate glucagon response to hypoglycemia resulting in sustained hypoglycemia in Pts 1 and 2. These data indicate that gross disturbances of the insulin-glucagon axis attend childhood dumping syndrome.

Log in or create a free account to read this content

Gain free access to this article, as well as selected content from this journal and more on nature.com

Access through your institution

or

Sign in or create an account

Continue with Google

Continue with ORCiD