HIPOGLUCEMIA HIPERINSULINÉMICA POSTPRANDIAL LUEGO DE LA CIRUGÍA BARIÁTRICA

María Graciela Álvarez, Susana Gutt, María Yuma, Paola Polo, Sandra González, Estrella Menéndez, Guadalupe Vanoli, Hugo Montemerlo, Marianela Ackerman, Jimena Coronel, Carla Gauna, Victoria Salinas, Carla Musso, Juliana Mociulsky, Susana Fuentes

Resumen


La incidencia de complicaciones informadas luego de la cirugía bariátrica (CB) ha ido en aumento en relación con la epidemia de obesidad y el mayor número de procedimientos quirúrgicos realizados a nivel mundial. Entre las complicaciones, la hipoglucemia hiperinsulinémica postprandial (HHP) adquirió relevancia, aunque es una de las menos conocidas y comprendidas de la cirugía bariátrica (CB), frecuentemente inadvertida y por lo tanto subdiagnosticada. Se distingue de la hipoglucemia de ayuno en que su presentación es típicamente posterior a la ingesta, asociada a valores de hipoglucemia precedidos por hiperglucemia e hiperinsulinemia en sangre. Se caracteriza por el incremento de la variabilidad de la glucemia, con absorción acelerada, aumento y caída rápida de azúcar en sangre, por lo que comprende valores de hiper e hipoglucemia. Debe sospecharse cuando se detectan síntomas adrenérgicos o de neuroglucopenia postprandiales luego de la CB1.

Ha sido considerada más frecuente luego del bypass gástrico en-Y-Roux (BGYR), pero también fue descripta asociada a otras técnicas quirúrgicas, como la derivación biliopancreática/switch duodenal (DBP/SD)2 y la gastrectomía vertical en manga (GVM), y de otras intervenciones que comprometen el píloro o el vaciamiento gástrico3. No se observó luego de la cirugía con banda gástrica ajustable, un procedimiento que no altera la anatomía gastrointestinal4-5.


Palabras clave


hipoglucemia hiperinsulinémica; hipoglucemia postprandial; cirugía bariátrica; bypass gástrico; dumping tardío

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Referencias


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DOI: http://dx.doi.org/10.47196/diab.v53i1.137