{
  "abstract": "Background/Objective: Postbariatric hypoglycemia is a recognized complication of Roux-en-Y gastric bypass. We report a case of refractory hypoglycemia following gastric bypass where genetic testing revealed variants that may have contributed to her presentation.\n\nCase report: A 26-year-old woman with a body mass index of 48.4 kg/m2 underwent Roux-en-Y gastric bypass and achieved ∼63 kg of weight loss. Subsequently, she developed recurrent postprandial hypoglycemia with glucose values in the 2.2 to 2.8 mmol/L range, with loss of consciousness. Evaluation excluded insulinoma as a cause. Continuous glucose monitoring confirmed delayed postprandial hypoglycemia. Targeted genetic testing using a 120-gene panel identified a heterozygous pathogenic ABCC8 variant c.1332G>T (p.Gln444His) and a GCK variant c.757G>A (p.Val253Ile) of uncertain significance. Sequential pharmacotherapy with acarbose +/– octreotide 50 μg sc 3 times daily + diazoxide 175 mg 3 times daily yielded only partial improvement (Fig. 1). The patient underwent an open Branco-Zorron switch procedure, after which hypoglycemic episodes decreased in frequency and severity on low-dose octreotide at 4 months of follow-up.\n\nDiscussion: The identification of a genetic susceptibility in this patient suggests that latent genetic susceptibility to hypoglycemia may predispose to severe hypoglycemia when unmasked by the metabolic changes following bariatric surgery. This is especially relevant given that hyperinsulinemia is associated with weight gain.\n\nConclusion: This case raises the possibility that preoperative genetic screening for hypoglycemia-associated variants may improve risk post-bariatric hypoglycemia stratification in bariatric surgery candidates.",
  "abstract_shown": true,
  "affiliations": [
    "Division of Endocrinology, Diabetes, and Metabolism, State University of New York (SUNY) Upstate Medical University, Syracuse, New York",
    "Division of Bariatric Surgery, SUNY Upstate Medical University, Syracuse, New York"
  ],
  "article_type": "case report",
  "arxiv": null,
  "author_total": 6,
  "authors": [
    {
      "affs": [
        0
      ],
      "name": "Uchechi Adeniran"
    },
    {
      "affs": [
        0
      ],
      "name": "Ibrahim H. Topkaya"
    },
    {
      "affs": [
        1
      ],
      "name": "Timothy Shope"
    },
    {
      "affs": [
        0
      ],
      "name": "Melih Kasap"
    },
    {
      "affs": [
        0
      ],
      "name": "Tuncay Delibasi"
    },
    {
      "affs": [
        0
      ],
      "name": "Malek El Muayed"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/f8tpwqzdeenn7.bib",
  "cited_by": 0,
  "doi": "10.1016/j.aed.2026.06.012",
  "fulltext_url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC13728309/",
  "id": "f8tpwqzdeenn7",
  "issns": [
    "3050-9157"
  ],
  "landing_url": "https://doi.org/10.1016/j.aed.2026.06.012",
  "language": "en",
  "licence": "CC-BY-NC-ND-4.0",
  "licence_label": "CC BY-NC-ND 4.0",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by-nc-nd/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "heading",
      "Case Report"
    ],
    [
      "openalex",
      "2746|Bariatric Surgery and Outcomes"
    ]
  ],
  "openalex": "W7167472208",
  "pdf_url": "https://www.endocrinologydiabetes.org/article/S3050-9157(26)00141-4/pdf",
  "pmcid": "PMC13728309",
  "pmid": "42979049",
  "published": "2026-07-06",
  "publisher": "American Association of Clinical Endocrinology",
  "ris": "https://research.draconitic.com/paper/f8tpwqzdeenn7.ris",
  "sources": [
    {
      "first_seen": "2026-11-06T12:24:01Z",
      "native_id": "PMC13728309",
      "source": "pmc",
      "url": "https://doi.org/10.1016/j.aed.2026.06.012"
    }
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  "subjects": [
    {
      "field": "medicine",
      "origin": "openalex:2746|Bariatric Surgery and Outcomes",
      "subfield": "surgery"
    }
  ],
  "title": "When Weight Loss Surgery Meets Hidden Genetics: Lessons From a Case of Post–Bariatric Surgery Hypoglycemia With ABCC8 and GCK Mutation",
  "title_text": "When Weight Loss Surgery Meets Hidden Genetics: Lessons From a Case of Post–Bariatric Surgery Hypoglycemia With ABCC8 and GCK Mutation",
  "type": "peer-reviewed",
  "updated_at": "2026-11-06T12:24:01Z",
  "url": "https://research.draconitic.com/paper/f8tpwqzdeenn7",
  "venue": "AACE Endocrinology and Diabetes",
  "versions": []
}