Discovery of Cushing's Syndrome After Bariatric Surgery: Multicenter Series of 16 Patients.
OBJECTIVE
The aim of this study is to demonstrate the importance of considering Cushing's syndrome (CS) as a potential etiology for weight gain and metabolic complications in patients undergoing bariatric surgery (BS).


METHODS
This is a retrospective chart review case series of patients (n = 16) with CS from five tertiary care centers in the USA who had BS.


RESULTS
Median age at BS surgery was 35.5 years (median 2.5 years between BS and CS surgery). CS was not identified in 12 patients prior to BS. Four patients had CS surgery prior to BS, without recognition of recurrent or persistent CS until after BS. Median body mass index (BMI) values before BS, nadir after BS, prior to surgery for CS, and after surgery for CS were 47, 31, 38, and 35 kg/m(2), respectively. Prior to BS, 55 % of patients had hypertension and 55 % had diabetes mellitus. Only 17 % had resolution of hypertension or diabetes mellitus after BS.


CONCLUSIONS
CS may be under-recognized in patients undergoing BS. Testing for CS should be performed prior to BS in patients with features of CS and in post-operative BS patients with persistent hypertension, diabetes mellitus, or excessive weight regain. Studies should be conducted to determine the role of prospective testing for CS in subjects considering BS.
Endocrinology Center and Clinics, Froedtert and Medical College of Wisconsin, W129 N7055 Northfield Drive, Building A, Suite 203 Menomonee Falls, Milwaukee, WI, 53051, USA. bradley.javorsky@froedtert.com.
Bradley R
BR
Javorsky
Endocrinology Center and Clinics, Froedtert and Medical College of Wisconsin, W129 N7055 Northfield Drive, Building A, Suite 203 Menomonee Falls, Milwaukee, WI, 53051, USA.
Ty B
TB
Carroll
Neuroendocrine Unit, Massachusetts General Hospital, Boston, MA, USA.
Nicholas A
NA
Tritos
Division of Endocrinology, Diabetes and Metabolism and Pituitary Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Roberto
R
Salvatori
David Geffen School of Medicine, UCLA, Los Angeles, CA, USA.
Anthony P
AP
Heaney
Departments of Medicine and Neurological Surgery, Northwest Pituitary Center, Oregon Health & Science University, Portland, OR, USA.
Maria
M
Fleseriu
Neuroendocrine Unit, Massachusetts General Hospital, Boston, MA, USA.
Beverly M K
BM
Biller
Endocrinology Center and Clinics, Froedtert and Medical College of Wisconsin, W129 N7055 Northfield Drive, Building A, Suite 203 Menomonee Falls, Milwaukee, WI, 53051, USA.
James W
JW
Findling
D000328:Adult; D050110:Bariatric Surgery; D015992:Body Mass Index; D003480:Cushing Syndrome / Q000453:epidemiology* / Q000209:etiology; D005260:Female; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000453:epidemiology* / Q000601:surgery*; D011184:Postoperative Period; D012189:Retrospective Studies; D017211:Treatment Failure; D015430:Weight Gain; D055815:Young Adult
Causes of surgical failure; Cushing’s syndrome; Hormonal causes of weight gain; Hypercortisolism; Preoperative screening for bariatric surgery; Weight regain after surgery