Attenuated counterregulatory hormonal responses to severe hypoglycemia occur in patients with insulinoma,7, , , -11 in infants with PHHI,12,13 and in diabetic patients treated with excess exogenous insulin.14,15 Insulinoma resection mitigates hyperinsulinemic hypoglycemic episodes and is associated with restoration of physiologic counterregulatory hormone response to hypoglycemia.7, , , -11 We report 3 individuals who underwent RYGB complicated by NIPHS and subsequently developed adrenal insufficiency (AI). The gene discussed is INS; the disease is Hypoglycemia.