Thu, 21 Aug 2008 07:13:54 BST CiteULike: omalbams hypoglycemia http://www.citeulike.org/user/omalbam/tag/hypoglycemia CiteULike.org en-gb Copyright © 2004-2008 citeulike.org http://www.citeulike.org/user/omalbam/article/2223120 <i>J Clin Endocrinol Metab, Vol. 92, No. 12. (1 December 2007), pp. 4706-4711.</i><br /><br />Objectives: Focal lesions in infants with congenital hyperinsulinism (HI) represent areas of adenomatosis that express a paternally derived ATP-sensitive potassium channel mutation due to embryonic loss of heterozygosity for the maternal 11p region. This study evaluated the accuracy of 18F-fluoro-L-dihydroxyphenylalanine ([18F]DOPA) positron emission tomography (PET) scans in diagnosing focal vs. diffuse disease and identifying the location of focal lesions. Design: A total of 50 infants with HI unresponsive to medical therapy were studied. Patients were injected iv with [18F]DOPA, and PET scans were obtained for 5060 min. Images were coregistered with abdominal computed tomography scans. PET scan interpretations were compared with histological diagnoses. Results: The diagnosis of focal or diffuse HI was correct in 44 of the 50 cases (88%). [18F]DOPA PET identified focal areas of high uptake of radiopharmaceutical in 18 of 24 patients with focal disease. The locations of these lesions matched the areas of increased [18F]DOPA uptake on the PET scans in all of the cases. PET scan correctly located five lesions that could not be visualized at surgery. The positive predictive value of [18F]DOPA in diagnosing focal adenomatosis was 100%, and the negative predictive value was 81%. Conclusions: [18F]DOPA PET scans correctly diagnosed 75% of focal cases and were 100% accurate in identifying the location of the lesion. These results suggest that [18F]DOPA PET imaging provides a useful guide to surgical resection of focal adenomatosis and should be considered as a guide to surgery in all infants with congenital HI who have medically uncontrollable disease. 10.1210/jc.2007-1637 Accuracy of [18F]Fluorodopa Positron Emission Tomography for Diagnosing and Localizing Focal Congenital Hyperinsulinism Olga Hardy Miguel Hernandez-Pampaloni Janet Saffer Joshua Scheuermann Linda Ernst Richard Freifelder Hongming Zhuang Courtney Macmullen Susan Becker Scott Adzick Chaitanya Divgi Abass Alavi Charles Stanley doi:10.1210/jc.2007-1637 J Clin Endocrinol Metab, Vol. 92, No. 12. (1 December 2007), pp. 4706-4711. 2008-01-12T18:37:49-00:00 2007 J Clin Endocrinol Metab 92 12 4706 4711 diagnosis hypoglycemia pet http://www.citeulike.org/user/omalbam/article/2223114 <i>J Clin Endocrinol Metab, Vol. 92, No. 12. (1 December 2007), pp. 4678-4685.</i><br /><br />Context and Objective: Hyperinsulinemic hypoglycemia is newly recognized as a rare but important complication after Roux-en-Y gastric bypass (GB). The etiology of the syndrome and metabolic characteristics remain incompletely understood. Recent studies suggest that levels of incretin hormones are increased after GB and may promote excessive -cell function and/or growth. Patients and Methods: We performed a cross-sectional analysis of metabolic variables, in both the fasting state and after a liquid mixed-meal challenge, in four subject groups: 1) with clinically significant hypoglycemia [neuroglycopenia (NG)] after GB surgery, 2) with no symptoms of hypoglycemia at similar duration after GB surgery, 3) without GB similar to preoperative body mass index of the surgical cohorts, and 4) without GB similar to current body mass index of the surgical cohorts. Results: Insulin and C-peptide after the liquid mixed meal were both higher relative to the glucose level achieved in persons after GB with NG compared with asymptomatic individuals. Glucagon, glucagon-like peptide 1, and glucose-dependent insulinotropic peptide levels were higher in both post-GB surgical groups compared with both overweight and morbidly obese persons, and glucagon-like peptide 1 was markedly higher in the group with NG. Insulin resistance, assessed by homeostasis model assessment of insulin resistance, the composite insulin sensitivity index, or adiponectin, was similar in both post-GB groups. Dumping score was also higher in both GB groups but did not discriminate between asymptomatic and symptomatic patients. Notably, the frequency of asymptomatic hypoglycemia after a liquid mixed meal was high in post-GB patients. Conclusion: A robust insulin secretory response was associated with postprandial hypoglycemia in patients after GB presenting with NG. Increased incretin levels may contribute to the increased insulin secretory response. 10.1210/jc.2007-0918 Patients with Neuroglycopenia after Gastric Bypass Surgery Have Exaggerated Incretin and Insulin Secretory Responses to a Mixed Meal AB Goldfine EC Mun E Devine R Bernier M Baz-Hecht DB Jones BE Schneider JJ Holst ME Patti doi:10.1210/jc.2007-0918 J Clin Endocrinol Metab, Vol. 92, No. 12. (1 December 2007), pp. 4678-4685. 2008-01-12T18:34:40-00:00 2007 J Clin Endocrinol Metab 92 12 4678 4685 bariatric hypoglycemia incretin