Post-Splenectomy Hormonal Changes: Insulin Decrease
Insulin (B) is the hormone that will initially decrease 1 week after splenectomy for splenic laceration.
Physiological Basis
The spleen contains stem cells that serve as precursors to insulin-producing pancreatic cells, and removal of the spleen disrupts this relationship, leading to decreased insulin levels and subsequent hyperglycemia 1.
Evidence for Insulin Decrease
Long-term glucose dysregulation: Trauma splenectomy patients demonstrate significantly higher mean blood glucose levels compared to controls (114 ± 34 mg/dL versus 90 ± 13 mg/dL, P = 0.04) at long-term follow-up (mean 82.8 months) 1.
Increased hyperglycemia incidence: Splenectomy patients show significantly more episodes of blood glucose >130 mg/dL (4 patients versus 0 patients, P = 0.02) compared to trauma laparotomy controls 1.
New diabetes mellitus diagnoses: New-onset diabetes mellitus was documented exclusively in the trauma splenectomy cohort, not in control patients 1.
Why Not the Other Options
Glucagon (A)
- No evidence exists linking splenectomy to glucagon level changes
- The spleen does not play a documented role in glucagon production or regulation
- Glucagon is produced by pancreatic alpha cells, which are not affected by splenic removal
Vasopressin (C)
- Vasopressin is produced by the hypothalamus and stored in the posterior pituitary
- The spleen has no known role in vasopressin synthesis, storage, or regulation
- No literature supports vasopressin changes following splenectomy
Clinical Implications
Monitor blood glucose closely in the early post-splenectomy period, as the insulin-glucose relationship becomes disrupted within the first week and persists long-term 1. This represents an under-recognized metabolic complication of splenectomy that requires ongoing surveillance beyond the typical infectious and thromboembolic concerns 2.