Cushing's Syndrome in Patients who had Bariatric Surgery: A Multicenter Case Series

Program: Abstracts - Orals, Featured Poster Presentations, and Posters
Session: SAT 660-676-Clinical Obesity Treatment
Saturday, June 15, 2013: 1:45 PM-3:45 PM
Expo Halls ABC (Moscone Center)

Poster Board SAT-671
Bradley R Javorsky*1, Ty Brian Carroll1, Nicholas A Tritos2, Roberto Salvatori3, Anthony P Heaney4, Maria Fleseriu5, Beverly MK Biller6 and James W Findling1
1Medical College of Wisconsin, Milwaukee, WI, 2Massachusetts General Hospital/Harvard Medical School, Boston, MA, 3Johns Hopkins Univ Sch of Med, Baltimore, MD, 4UCLA-David Geffen Schl of Med, Los Angeles, CA, 5Northwest Pituitary Center, Oregon Health & Science University, Portland, OR, 6Massachusetts General Hospital, Boston, MA
Background: The dramatic rise in the prevalence of obesity has led to an increase in the number of bariatric surgeries (BaS) performed each year. Endogenous hypercortisolism, Cushing's syndrome (CS), is associated with weight gain and metabolic complications often attributed to obesity. There are currently no reported studies addressing the presence of CS in patients undergoing BaS. Current BaS guidelines do not recommend routine testing for CS and some even recommend against testing for CS prior to surgery. 

Setting: Endocrinologists at five academic medical centers with experience diagnosing and treating patients with CS were asked to recall patients found to have CS and BaS. 

Patients: Fifteen patients with CS who had BaS between 1997 and 2011 were identified. All patients were female with a median age of 38 years (range 29-60) at the time of the first surgery for CS. Fourteen patients had Cushing’s disease (CD) and 1 had a cortisol-secreting adrenal adenoma. Eleven patients underwent Roux-en Y gastric bypass and 4 underwent laparoscopic adjustable gastric band placement. CS was not identified in 11 patients prior to bariatric surgery, and 2 of these patients had pre-bariatric surgery testing with normal urine free cortisol. Four patients had pituitary surgery for CD prior to BaS, with recognition of recurrent or persistent CD after BaS. 

Results: Median time of surgical treatment for CS after BaS in these patients was 2 years (range 1-14 years). Median weight loss nadir after BaS was 35.2 kg (range 0-72.5 kg). There was a median weight gain of 10 kg (range 2.2-22.6 kg) between the nadir of weight loss after BaS and the first surgery for CS, and median weight loss of 3.6 kg (range 9 kg weight gain to 26.7 kg weight loss) after CS surgery. Of patients with evaluable data, 66.6% had hypertension, diabetes mellitus, or both prior to BaS, and 60% of patients had these conditions after BaS. Following surgery for CS, 46.1% of patients with evaluable data had hypertension and/or diabetes mellitus. 

Conclusion: This multicenter case series demonstrates that CS may be unrecognized in patients undergoing BaS for obesity. We believe an evaluation for CS should be considered in post-operative BaS patients with persistent hypertension, diabetes mellitus, or excessive weight regain. Studies should be conducted to determine the value of prospective testing for CS in subjects considering BaS.

Disclosure: BRJ: Researcher, Novartis Pharmaceuticals. TBC: Researcher, Corcept, Speaker, Corcept. NAT: Principal Investigator, Pfizer, Inc., Investigator, Ipsen, Medical Advisory Board Member, Corcept, , Pfizer, Inc.. APH: Medical Advisory Board Member, Ipsen, Medical Advisory Board Member, Novartis Pharmaceuticals. MF: Principal Investigator, Corcept, Principal Investigator, Ipsen, Consultant, Ipsen, Principal Investigator, Novartis Pharmaceuticals, Consultant, Novartis Pharmaceuticals. BMB: Investigator, Novartis Pharmaceuticals, Consultant, Novartis Pharmaceuticals, Investigator, Corcept, Consultant, HRA Pharma. JWF: Investigator, Novartis Pharmaceuticals, Consultant, Corcept, Consultant, Abbott Laboratories. Nothing to Disclose: RS

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