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Approach to the Patient with Postprandial Hypoglycemia.
Endocr Pract. 2013 Nov 18;:1-28
Authors: Galati SJ, Rayfield EJ
Abstract
Objectives: Postprandial hypoglycemia in a non-diabetic patient is a frequent chief complaint across all medical specialties and imparts a significant diagnostic challenge.Methods: We conducted an electronic and print literature search using PubMed for articles published in the last 40 years using the key words "postprandial hypoglycemia," "reactive hypoglycemia," and "hyperinsulinemic hypoglycemia." All available sources were reviewed, and publications were included based on clinical relevance.Results: Over the last century, the classification, etiologies, diagnosis, and management of hypoglycemia have evolved considerably. In the contemporary literature, the evaluation of hypoglycemia is divided into the well-appearing and ill-appearing patient. Symptoms of hypoglycemia in the well-appearing patient may result from insulinoma, the noninsulinoma pancreatogenous hypoglycemia syndrome (NIPHS), post-bariatric surgery hypoglycemia, dumping syndrome, insulin autoimmunity, or the postprandial syndrome. For each of these, the literature is lacking in randomized clinical trials investigating the optimal diagnostic and treatment modalities, both related to the relatively recent description of some diseases and the rarity of cases.Conclusion: This review provides an overview of postprandial hypoglycemia and summarizes the proposed pathophysiologic mechanisms of postprandial hypoglycemia, with special attention to some of the more recently described syndromes, such as NIPHS and post-bariatric surgery hypoglycemia. In addition, diagnostic and management strategies are discussed.
PMID: 24246338 [PubMed - as supplied by publisher]