Pseudoinsulinoma. Alimentary tract hypoglycemia revisited.

Knowing that hypoglycemia and inappropriate plasma insulin levels and insulin-glucose ratios can occur after gastric surgery may prevent unwarranted exploration for insulinoma in patients with alimentary tract hypoglycemia (ATH). Absolute differentiation may be achieved by comparing the insulin-glucose ratios obtained during a 72-hour fast with those obtained during an oral glucose tolerance test. The treatment of ATH is primarily medical, surgery being reserved for those patients in whom diet and drug therapy fails. For such medically intractable patients , reversal of a 10-cm segment of jejunum at the gastroenteric stoma is highly effective in controlling the symptoms of hypoglycemia.