{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,26]],"date-time":"2026-03-26T19:02:53Z","timestamp":1774551773293,"version":"3.50.1"},"reference-count":20,"publisher":"Bioscientifica","issue":"1","license":[{"start":{"date-parts":[[2026,1,1]],"date-time":"2026-01-01T00:00:00Z","timestamp":1767225600000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["edm.bioscientifica.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2026,1,1]]},"abstract":"\n Summary<\/jats:title>\n We report a 26-year-old woman, five years after sleeve gastrectomy, who presented with a two-year history of recurrent postprandial hypoglycemia. During symptomatic episodes (blood glucose as low as 37 mg\/dL), she experienced adrenergic symptoms (tremors, hunger, and sweating) and neuroglycopenic symptoms (dizziness), with one brief episode of syncope. Initial evaluations showed normal liver and renal function, thyroid profile, electrolytes, and HbA1c. Adrenal insufficiency was ruled out (elevated morning cortisol), and a toxicology screen for hypoglycemic agents was negative. A supervised 72 h fast provoked symptomatic hypoglycemia at 16 h (plasma glucose: 41 mg\/dL), with appropriately suppressed insulin and C-peptide levels, confirming a non-insulin-mediated hypoglycemia. Venous blood gas during hypoglycemia revealed high-anion-gap metabolic acidosis with minimal lactate elevation, plus positive ketones, consistent with a ketotic hypoglycemia. Given her short stature (144 cm) and these findings, we investigated the growth hormone (GH) axis. Insulin-like growth factor 1 (IGF-1) and IGF-binding protein 3 (IGFBP-3) were markedly low at baseline. GH levels were inappropriately low during the hypoglycemic episode. A glucagon stimulation test showed a peak GH of only 0.07 ng\/mL, confirming severe GH deficiency. Other pituitary hormones were within normal ranges, and pituitary MRI showed no abnormalities. The patient was started on low-dose recombinant human GH replacement therapy, gradually titrated to normalize IGF-1. With GH therapy, her hypoglycemic episodes completely resolved and she reported improved energy and an ability to fast without symptoms.<\/jats:p>\n <\/jats:sec>\n \n Learning points<\/jats:title>\n \n \n Short stature in adults should prompt re-evaluation, especially when presenting with unexplained metabolic disturbances such as recurrent hypoglycemia.<\/jats:p>\n <\/jats:list-item>\n \n Adult GH deficiency is a rare but important cause of recurrent hypoglycemia, particularly in patients with short stature or a history of endocrine disorders.<\/jats:p>\n <\/jats:list-item>\n \n Postprandial hypoglycemia in non-diabetic patients after bariatric surgery warrants consideration of both insulin-mediated and non-insulin-mediated etiologies, including hormonal deficiencies.<\/jats:p>\n <\/jats:list-item>\n \n GH replacement therapy can lead to resolution of hypoglycemia and improved metabolic stability in post-bariatric patients with isolated GH deficiency.<\/jats:p>\n <\/jats:list-item>\n \n Adult GH deficiency should be considered in post-sleeve gastrectomy patients presenting with unexplained non-insulin-mediated hypoglycemia, particularly when clinical or historical clues are present.<\/jats:p>\n <\/jats:list-item>\n <\/jats:list>\n <\/jats:sec>","DOI":"10.1530\/edm-25-0068","type":"journal-article","created":{"date-parts":[[2026,1,22]],"date-time":"2026-01-22T15:46:50Z","timestamp":1769096810000},"update-policy":"https:\/\/doi.org\/10.1530\/crossmarkpolicy-2","source":"Crossref","is-referenced-by-count":0,"title":["Unusual cause of post-bariatric non-insulin-mediated hypoglycemia due to adult growth hormone deficiency"],"prefix":"10.1530","volume":"2026","author":[{"given":"Alhussain M","family":"Hakami","sequence":"first","affiliation":[{"name":"King Fahad Central Hospital (KFCH), Gizan, Saudi Arabia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mohammed Ali","family":"Summ","sequence":"additional","affiliation":[{"name":"King Fahad Central Hospital (KFCH), Gizan, Saudi Arabia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ashwag","family":"Alfagih","sequence":"additional","affiliation":[{"name":"King Fahad Central Hospital (KFCH), Gizan, Saudi Arabia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mohammed Ahmed","family":"Alhazmi","sequence":"additional","affiliation":[{"name":"King Fahad Central Hospital (KFCH), Gizan, Saudi Arabia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Aiyl","family":"Nami","sequence":"additional","affiliation":[{"name":"King Fahad Central Hospital (KFCH), Gizan, Saudi Arabia"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"416","reference":[{"issue":"Online Edition","key":"bib1","series-title":"Hypoglycemia in adults: pathophysiology, diagnosis, and treatment","first-page":"1","author":"Cryer PE","year":"2023","unstructured":"Cryer PE\n\n. In Hypoglycemia in adults: pathophysiology, diagnosis, and treatment (Online Edition), pp 1\u201327. Oxford Academic: New York, NY, 2023. (https:\/\/doi.org\/10.1093\/oso\/9780195113259.001.0001)"},{"key":"bib2","series-title":"J Clin Endocrinol Metab","first-page":"e456","article-title":"A 2024 update on adult growth hormone deficiency: diagnosis and treatment challenges","volume":"109","author":"Yuen KCJ","year":"2024","unstructured":"Yuen KCJ\n, \nBiller BMK\n, \nRadovick S\n, et al.\n A 2024 update on adult growth hormone deficiency: diagnosis and treatment challenges. J Clin Endocrinol Metab 2024 109 e456\u2013e464."},{"key":"bib3","series-title":"Expert Rev Endocrinol Metab","first-page":"187","article-title":"An overview of the controversies of adult growth hormone deficiency diagnosis","volume":"20","author":"Cuboni D","year":"2025","unstructured":"Cuboni D\n, \nAversa LS\n, \nGrottoli S\n, et al.\n An overview of the controversies of adult growth hormone deficiency diagnosis. Expert Rev Endocrinol Metab 2025 20 187\u2013200. (https:\/\/doi.org\/10.1080\/17446651.2025.2480699)"},{"key":"bib4","series-title":"J Endocr Soc","first-page":"bvac077","article-title":"Adult growth hormone deficiency: diagnostic and therapeutic challenges","volume":"6","author":"Hoffman AR","year":"2022","unstructured":"Hoffman AR\n, \nMathison T\n, \nAndrews D\n, et al\n. Adult growth hormone deficiency: diagnostic and therapeutic challenges. J Endocr Soc 2022 6 bvac077. (https:\/\/doi.org\/10.1210\/jendso\/bvac077)"},{"key":"bib5","series-title":"J Pediatr","first-page":"238","article-title":"Recommendations from the pediatric endocrine society for evaluation and management of persistent hypoglycemia in neonates, infants, and children","volume":"167","author":"Thornton PS","year":"2015","unstructured":"Thornton PS\n, \nStanley CA\n, \nDe Leon DD\n, et al.\n Recommendations from the pediatric endocrine society for evaluation and management of persistent hypoglycemia in neonates, infants, and children. J Pediatr 2015 167 238\u2013245. (https:\/\/doi.org\/10.1016\/j.jpeds.2015.03.057)"},{"key":"bib6","series-title":"Endocrinol Diabetes Metab Case Rep","first-page":"20","article-title":"Hypoglycemia after bariatric surgery: importance of exhaustive hormonal study","volume":"2021","author":"Perez-Montes de Oca A","year":"2021","unstructured":"Perez-Montes de Oca A\n, \nPellitero S\n & \nPuig-Domingo M\n\n. Hypoglycemia after bariatric surgery: importance of exhaustive hormonal study. Endocrinol Diabetes Metab Case Rep 2021 2021 20\u20130131. (https:\/\/doi.org\/10.1530\/EDM-20-0131)"},{"key":"bib7","series-title":"Gastroenterology","first-page":"605","article-title":"Hypoglycemia after gastric bypass: the dark side of GLP-1","volume":"146","author":"Patti ME","year":"2014","unstructured":"Patti ME\n & \nGoldfine AB\n\n. Hypoglycemia after gastric bypass: the dark side of GLP-1. Gastroenterology 2014 146 605\u2013608. (https:\/\/doi.org\/10.1053\/j.gastro.2014)"},{"key":"bib8","series-title":"J Clin Endocrinol Metab","first-page":"2815","article-title":"Hypoglycemia after gastric bypass surgery: current concepts and controversies","volume":"103","author":"Salehi M","year":"2018","unstructured":"Salehi M\n, \nVella A\n, \nMcLaughlin T\n, et al.\n Hypoglycemia after gastric bypass surgery: current concepts and controversies. J Clin Endocrinol Metab 2018 103 2815\u20132826. (https:\/\/doi.org\/10.1210\/jc.2018-00528)"},{"key":"bib9","series-title":"Case Rep Endocrinol","first-page":"8658540","article-title":"Hyperinsulinemic hypoglycemia and growth hormone deficiency secondary to 20p11 Deletion","volume":"2023","author":"Wee E","year":"2023","unstructured":"Wee E\n, \nHerriges J\n & \nDileepan K\n\n. Hyperinsulinemic hypoglycemia and growth hormone deficiency secondary to 20p11 Deletion. Case Rep Endocrinol 2023 2023 8658540. (https:\/\/doi.org\/10.1155\/2023\/8658540)"},{"key":"bib10","series-title":"Front Endocrinol","article-title":"Editorial: New insights and controversies in the diagnosis and management of adult growth hormone deficiency","volume":"12","author":"Mancini A","year":"2022","unstructured":"Mancini A\n, \nArosio M\n, \nKreitschmann-Andermahr I\n, et al\n. Editorial: New insights and controversies in the diagnosis and management of adult growth hormone deficiency. Front Endocrinol 2022 12 819527. (https:\/\/doi.org\/10.3389\/fendo.2021.819527)"},{"issue":"Online Edition","key":"bib1","series-title":"Hypoglycemia in adults: pathophysiology, diagnosis, and treatment","first-page":"1","author":"Cryer PE","year":"2023","unstructured":"Cryer PE\n\n. In Hypoglycemia in adults: pathophysiology, diagnosis, and treatment (Online Edition), pp 1\u201327. Oxford Academic: New York, NY, 2023. (https:\/\/doi.org\/10.1093\/oso\/9780195113259.001.0001)"},{"key":"bib2","series-title":"J Clin Endocrinol Metab","first-page":"e456","article-title":"A 2024 update on adult growth hormone deficiency: diagnosis and treatment challenges","volume":"109","author":"Yuen KCJ","year":"2024","unstructured":"Yuen KCJ\n, \nBiller BMK\n, \nRadovick S\n, et al.\n A 2024 update on adult growth hormone deficiency: diagnosis and treatment challenges. J Clin Endocrinol Metab 2024 109 e456\u2013e464."},{"key":"bib3","series-title":"Expert Rev Endocrinol Metab","first-page":"187","article-title":"An overview of the controversies of adult growth hormone deficiency diagnosis","volume":"20","author":"Cuboni D","year":"2025","unstructured":"Cuboni D\n, \nAversa LS\n, \nGrottoli S\n, et al.\n An overview of the controversies of adult growth hormone deficiency diagnosis. Expert Rev Endocrinol Metab 2025 20 187\u2013200. (https:\/\/doi.org\/10.1080\/17446651.2025.2480699)"},{"key":"bib4","series-title":"J Endocr Soc","first-page":"bvac077","article-title":"Adult growth hormone deficiency: diagnostic and therapeutic challenges","volume":"6","author":"Hoffman AR","year":"2022","unstructured":"Hoffman AR\n, \nMathison T\n, \nAndrews D\n, et al\n. Adult growth hormone deficiency: diagnostic and therapeutic challenges. J Endocr Soc 2022 6 bvac077. (https:\/\/doi.org\/10.1210\/jendso\/bvac077)"},{"key":"bib5","series-title":"J Pediatr","first-page":"238","article-title":"Recommendations from the pediatric endocrine society for evaluation and management of persistent hypoglycemia in neonates, infants, and children","volume":"167","author":"Thornton PS","year":"2015","unstructured":"Thornton PS\n, \nStanley CA\n, \nDe Leon DD\n, et al.\n Recommendations from the pediatric endocrine society for evaluation and management of persistent hypoglycemia in neonates, infants, and children. J Pediatr 2015 167 238\u2013245. (https:\/\/doi.org\/10.1016\/j.jpeds.2015.03.057)"},{"key":"bib6","series-title":"Endocrinol Diabetes Metab Case Rep","first-page":"20","article-title":"Hypoglycemia after bariatric surgery: importance of exhaustive hormonal study","volume":"2021","author":"Perez-Montes de Oca A","year":"2021","unstructured":"Perez-Montes de Oca A\n, \nPellitero S\n & \nPuig-Domingo M\n\n. Hypoglycemia after bariatric surgery: importance of exhaustive hormonal study. Endocrinol Diabetes Metab Case Rep 2021 2021 20\u20130131. (https:\/\/doi.org\/10.1530\/EDM-20-0131)"},{"key":"bib7","series-title":"Gastroenterology","first-page":"605","article-title":"Hypoglycemia after gastric bypass: the dark side of GLP-1","volume":"146","author":"Patti ME","year":"2014","unstructured":"Patti ME\n & \nGoldfine AB\n\n. Hypoglycemia after gastric bypass: the dark side of GLP-1. Gastroenterology 2014 146 605\u2013608. (https:\/\/doi.org\/10.1053\/j.gastro.2014)"},{"key":"bib8","series-title":"J Clin Endocrinol Metab","first-page":"2815","article-title":"Hypoglycemia after gastric bypass surgery: current concepts and controversies","volume":"103","author":"Salehi M","year":"2018","unstructured":"Salehi M\n, \nVella A\n, \nMcLaughlin T\n, et al.\n Hypoglycemia after gastric bypass surgery: current concepts and controversies. J Clin Endocrinol Metab 2018 103 2815\u20132826. (https:\/\/doi.org\/10.1210\/jc.2018-00528)"},{"key":"bib9","series-title":"Case Rep Endocrinol","first-page":"8658540","article-title":"Hyperinsulinemic hypoglycemia and growth hormone deficiency secondary to 20p11 Deletion","volume":"2023","author":"Wee E","year":"2023","unstructured":"Wee E\n, \nHerriges J\n & \nDileepan K\n\n. Hyperinsulinemic hypoglycemia and growth hormone deficiency secondary to 20p11 Deletion. Case Rep Endocrinol 2023 2023 8658540. (https:\/\/doi.org\/10.1155\/2023\/8658540)"},{"key":"bib10","series-title":"Front Endocrinol","article-title":"Editorial: New insights and controversies in the diagnosis and management of adult growth hormone deficiency","volume":"12","author":"Mancini A","year":"2022","unstructured":"Mancini A\n, \nArosio M\n, \nKreitschmann-Andermahr I\n, et al\n. Editorial: New insights and controversies in the diagnosis and management of adult growth hormone deficiency. Front Endocrinol 2022 12 819527. 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