Session: SAT 660-676-Clinical Obesity Treatment
Poster Board SAT-671
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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