Most patients with Cushing’s syndrome not only experience weight gain but also develop health complications, such as diabetes mellitus and hypertension. These complications overlap with those seen in patients who seek surgery for weight loss (bariatric surgery). Expert recommendations from many medical societies, including the American Association of Clinical Endocrinologists, Obesity Society, American Society for Metabolic and Bariatric Surgery, and Endocrine Society, do not currently include routine screening for Cushing’s syndrome in bariatric surgery patients.

At the annual Endocrine Society meeting in June 2013, our group at the Medical College of Wisconsin, Milwaukee, WI, along with four other sites across the United States (Massachusetts General Hospital, Boston, MA; John Hopkins University School of Medicine, Baltimore, MD; UCLA-David Geffen School of Medicine, Los Angeles, CA; Oregon Health & Science University, Portland, OR) reported 16 patients found to have new or recurrent Cushing’s syndrome several years after bariatric surgery. All patients were women. Most had a pituitary source for their Cushing’s syndrome (Cushing’s disease). Four of the patients had unsuccessful surgery to treat Cushing’s disease before bariatric surgery. Interestingly, the patients who had new or recurrent Cushing’s syndrome lost just as much weight initially after bariatric surgery as the average person who undergoes bariatric surgery. However, diabetes mellitus and hypertension did not go into remission as a result of the weight loss following surgery and unfortunately, it appears that many of these patients have significant, and greater than expected, weight regain after bariatric surgery.

We concluded from these findings that new or incompletely treated Cushing’s syndrome might be present in some patients planning to have bariatric surgery. These patients should be asked about a history of Cushing’s syndrome. Those with a history of Cushing’s syndrome should be re-evaluated to look for a recurrence. For those patients, focusing on the treatment of Cushing’s syndrome may be more appropriate than proceeding with bariatric surgery. We also suggested that Cushing’s syndrome be considered in patients with incomplete resolution of hypertension or diabetes mellitus after bariatric surgery. Finally, we believe that further studies are needed to determine if all patients planning to have bariatric surgery should first be tested for Cushing’s syndrome.

Author: Dr. Bradley Javorsky, MD (Summer, 2013)

Editor’s note: Dr. Javorsky is Assistant Professor of Medicine, Endocrinology Center and Clinics at the Medical College of Wisconsin. Dr. Javorsky received his medical degree from the University of Wisconsin in Madison, Wisconsin. He went on to do residency and fellowship at the University of Virginia in Charlottesville, Virginia. He has been practicing endocrinology since 2008 at the Medical College of Wisconsin in Milwaukee, Wisconsin. He has a special interest in obesity and conditions of the pituitary/hypothalamus.

Reference

Endocrine Society, 2013 Annual Meeting, Poster 671. Javorsky BR, Carroll TB, Tritos NA, Salvatori R, Heaney AP, Fleseriu M, Biller BMK, Findling JW. Cushing’s syndrome in patients who had bariatric surgery: a multicenter case series.