title: Diabetes mellitus-associated diffuse autonomic dysfunction causing debilitating hypotension manifested after rapid weight loss in a morbidly obese patient: case report and review of the literature.
abstract: The association between weight and blood pressure is well established, especially the paradigm of obesity-related hypertension. The relationship between diffuse autonomic dysfunction and orthostatic hypotension in patients with long-term diabetes mellitus is also well known. We report on a 57-year-old morbidly obese male with a long medical history of hypertension, myocardial infarction, type 2 diabetes mellitus, and hypothyroidism. After a loss of 147 pounds (representing a percent excess weight loss of 76%) within 6 months after gastric bypass surgery, the patient developed worsening orthostatic hypotension and near-syncopal episodes requiring medication. The subsequent diagnosis and treatment, as well as a literature review, are presented.
authors.affiliation: The Bariatric Institute, Cleveland Clinic Florida, Weston, 33331, USA.
authors.forename: Charles A
authors.initials: CA
authors.lastname: Lascano
authors.forename: Samuel
authors.initials: S
authors.lastname: Szomstein
authors.forename: Natan
authors.initials: N
authors.lastname: Zundel
authors.forename: Raul J
authors.initials: RJ
authors.lastname: Rosenthal
mesh_terms: D000713:Anastomosis, Roux-en-Y; D001341:Autonomic Nervous System / Q000503:physiopathology*; D015897:Comorbidity; D003924:Diabetes Mellitus, Type 2 / Q000150:complications* / Q000503:physiopathology; D015390:Gastric Bypass / Q000379:methods*; D006801:Humans; D007024:Hypotension, Orthostatic / Q000209:etiology* / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000601:surgery*; D015431:Weight Loss