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Vilarrasa N, Goday A, Rubio MA, Caixàs A, Pellitero S, Ciudin A, Calañas A, Botella JI, Bretón I, Morales MJ, Díaz-Fernández MJ, García-Luna PP, Lecube A. Hyperinsulinemic Hypoglycemia after Bariatric Surgery: Diagnosis and Management Experience from a Spanish Multicenter Registry. Obes Facts 2016; 9:41-51. [PMID: 26901345 PMCID: PMC5644871 DOI: 10.1159/000442764] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Accepted: 11/24/2015] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Severe postprandial hypoglycemia after bariatric surgery is a rare but invalidating complication. Our aim was to describe the different tests performed for its diagnosis and their outcomes as well as the response to the prescribed pharmacological and surgical treatments. METHODS Multicenter, retrospective systematic review of cases with recurrent severe postprandial hypoglycemia. RESULTS Over 11 years of follow-up, 22 patients were identified. The test most used to provoke hypoglycemia was the oral glucose load test followed by the mixed meal test which was the least standardized test. With pharmacological treatment, 3 patients were symptom-free (with octreotide) and in 12 patients hypoglycemic episodes were attenuated. Seven patients had persistent hypoglycemic episodes and underwent surgery. Partial pancreatectomy was performed in 3 patients who had positive selective arterial calcium stimulation, and nesidioblastosis was confirmed in 2 patients. Reconversion to normal anatomy was performed in 3 patients, and 1 patient underwent a resection of the 'candy cane' roux limb, with resolution of hypoglycemia in all cases. CONCLUSIONS There is high heterogeneity in the evaluation and treatment options for postoperative hypoglycemia. In patients that do not respond to pharmacological treatment, reconstruction of gastrojejunal continuity may be the safest and most successful procedure.
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Affiliation(s)
- Nuria Vilarrasa
- Department of Endocrinology and Nutrition, Hospital Universitario de Bellvitge-IDIBELL, Lx00B4;Hospitalet de Llobregat, Barcelona, Spain
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Arrieta F, Balsa JA, de la Puerta C, Botella JI, Zamarrón I, Elías E, Del Río JIP, Alonso P, Candela A, Blanco-Colio LM, Egido J, Navarro P, Vázquez C. Phase IV prospective clinical study to evaluate the effect of taurine on liver function in postsurgical adult patients requiring parenteral nutrition. Nutr Clin Pract 2014; 29:672-80. [PMID: 24829298 DOI: 10.1177/0884533614533610] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Taurine's role in bile acid metabolism and anti-inflammatory activity could exert a protective effect on hepatobiliary complications associated with parenteral nutrition (PN). In this study, the effects of 2 amino acid solutions, with and without taurine, on liver function administered to nonacutely ill postsurgical patients as part of a short-term PN regimen were prospectively compared. METHODS Adult patients randomly received (double-blind) Tauramin 10% or a standard PN solution without taurine as the control (1.5 g amino acid/kg body weight [bw]/d; infusion rate of ≤4 mg glucose/kg bw/d) for a period of 5-30 days. γ-Glutamyl transpeptidase (GGT) and other indicators of liver function, glucose metabolism, lipid profile, inflammation markers, and treatment safety data were collected. RESULTS Thirty-five patients receiving taurine PN and 39 receiving control PN were enrolled (intention-to-treat [ITT] population). Most patients (n = 62) discontinued after day 7 of follow-up (per-protocol [PP] population: n = 24 and n = 27, respectively). ITT patients with high GGT values after 5 days of PN comprised 68.6% and 64.1%, respectively. The mean change in GGT values with respect to the baseline values was 167 ± 192 and 157 ± 185 IU/L, respectively. Low-density lipoprotein (LDL) cholesterol levels after 7 days of PN were significantly decreased in the taurine PN group of PP patients (-2.83 ± 30.9 vs 23.9 ± 27.0 mg/dL for control PN; P < .05). None of the adverse events reported (taurine PN: n = 6; control PN: n = 7) were treatment related. CONCLUSION PN solutions with and without taurine had similar effects on liver function parameters, except for an LDL reduction in PN with taurine, when administered to nonacutely ill postsurgical patients in the short term (5-7 days).
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Affiliation(s)
- Francisco Arrieta
- Unidad de Nutrición y Dietética, Obesidad y Metabolismo, Hospital Universitario Ramón y Cajal, Ciber de Obesidad y Nutrición (CIBEROBN), Madrid, Spain
| | - José Antonio Balsa
- Unidad de Nutrición y Dietética, Obesidad y Metabolismo, Hospital Universitario Ramón y Cajal, Ciber de Obesidad y Nutrición (CIBEROBN), Madrid, Spain
| | - Cristina de la Puerta
- Unidad de Nutrición y Dietética, Obesidad y Metabolismo, Hospital Universitario Ramón y Cajal, Ciber de Obesidad y Nutrición (CIBEROBN), Madrid, Spain
| | - José Ignacio Botella
- Unidad de Nutrición y Dietética, Obesidad y Metabolismo, Hospital Universitario Ramón y Cajal, Ciber de Obesidad y Nutrición (CIBEROBN), Madrid, Spain
| | - Isabel Zamarrón
- Unidad de Nutrición y Dietética, Obesidad y Metabolismo, Hospital Universitario Ramón y Cajal, Ciber de Obesidad y Nutrición (CIBEROBN), Madrid, Spain
| | - Elena Elías
- Servicio de Anestesia, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | | | - Paloma Alonso
- Servicio de Anestesia, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Angel Candela
- Servicio de Anestesia, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | | | - Jesús Egido
- Laboratorio de Patología Vascular, Madrid, Spain CIBERDEM, IIS-Fundación Jiménez Díaz, Universidad Autónoma de Madrid, Madrid, Spain
| | - Pilar Navarro
- Servicio de Farmacia, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Clotilde Vázquez
- Unidad de Nutrición y Dietética, Obesidad y Metabolismo, Hospital Universitario Ramón y Cajal, Ciber de Obesidad y Nutrición (CIBEROBN), Madrid, Spain
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Chu D, Chamorro S, Arrieta F, Cobo ME, Calañas A, Botella JI, Balsa J, Zamarrón I, Vázquez C. [Percutaneous gastrostomy complicated with abdominal wall hematoma; severe anemia secondary to percutaneous endoscopic gastrostomy]. NUTR HOSP 2012; 27:1361-3. [PMID: 23165587 DOI: 10.3305/nh.2012.27.4.5828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2012] [Accepted: 03/02/2012] [Indexed: 12/01/2022] Open
Abstract
Endoscopic percutaneous gastrostomy (PEG) is a safe and effective procedure that offers clear advantages over nasogastric tube feeding to ensure adequate nutrition in patients with swallowing problems who have an intact digestive tract. With proper placement and monitoring methodology there are few complications in both the peritrack procedure as in the long run. However, despite being considered a safe technique it is not devoided of serious complications. We report a patient with dysphagia, requiring percutaneous endoscopic gastrostomy placement developing a severe anemia with severe subcutaneous hematoma, given the exceptional case and literature review.
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Affiliation(s)
- D Chu
- Servicio de Endocrinología y Nutrición, Hospital General Yagüe, Burgos, España
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De Luis DA, Lahera M, Botella JI, Valero MA, Varela C. [Efficacy of quinagolide in the treatment of a patient with hypophyseal resistance to thyroid hormones]. An Med Interna 2001; 18:259-61. [PMID: 11496561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/21/2023]
Abstract
The pituitary resistance to thyroid hormones (PRTH) is not very frequent and well-known entity, their treatment it continues being topic of controversy. In this work we have evaluated the quinagolida effectiveness in the treatment of it unites patient with (PRTH). The relationship among thyroid stimulating hormone (TSH) and free triiodothyronine (FT3) it was used as marker of the thyroid resistance and of the response to the treatment. The concentrations of TSH and FT3 were normalized after adding quinagolida to methimazole. These results suggest that the quinagolida could be an useful drug in the treatment of this pathology, next to the classic treatments.
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Affiliation(s)
- D A De Luis
- Sec. Endocrinología y Nutrición, Hospital Río Hortega, Instituto Endocrinología y Nutrición, Facultad de Medicina, Valladolid, Departamento Endocrinología, Hospital Ramón y Cajal, Madrid
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De Luis DA, Becerra A, Lahera M, Botella JI, Varela C. A randomized cross-over study comparing cabergoline and quinagolide in the treatment of hyperprolactinemic patients. J Endocrinol Invest 2000; 23:428-34. [PMID: 11005266 DOI: 10.1007/bf03343751] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Quinagolide (QUI) and cabergoline (CAB) are dopamine agonists recently introduced for the treatment of hyperprolactinemia. In the present study, these drugs have been compared in terms of effectiveness and tolerability. Twenty patients (18 females and 2 males) with hyperprolactinemia (8 with microprolactinomas, 6 with idiopathic hyperprolactinemia and 6 with empty sella turcica syndrome) were treated with oral QUI (75 microg once daily) and CAB (0,5 mg twice weekly), in a randomized cross-over trial with placebo between both drugs. Each drug was administered for 12 weeks, separated by other 12 weeks with placebo. PRL levels decreased with both drugs at 2 or 4 weeks of starting the treatment, without differences between both drugs at weeks 4, 8 and 12. At week 12, normal PRL levels (<20 ng/ml) were attained in 90% patients with CAB and only in 75% patients with QUI (p<0.05). After discontinuation of treatment, significant increase in serum PRL was higher after QUI withdrawal than after CAB. Clinical efficacy of both treatments was similar in terms of improvement amenorrhea, oligomenorrhea, galactorrhea, and impotence. All patients completed both cycles of treatment, and the most frequent side-effects were nausea, headache and dizziness, without significant differences between CAB (30%) and QUI (55%). Our study indicates that, at the doses employed here, CAB showed a high percentage of patients with normal PRL at the end of treatment and long-lasting efficacy in the levels of PRL. Clinical response and side-effects were similar in both drugs.
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Affiliation(s)
- D A De Luis
- Institute of Endocrinology and Nutrition, Medicine School, Valladolid, Spain.
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