Question: I’m 40 years old and had a bilateral adrenalectomy 2 years ago, thus am on 20mg/day Cortef replacement. I feel alot better, but have not been able to lose the weight. Since I am considered obese, my doctor is now talking about gastric bypass surgery. I was wondering if anyone has any experience with that procedure in a Cushing’s patient, particularly someone who is dependent on replacement medications?

Answer: Weight loss after Cushing’s remission can take quite a while, even when patients are on physiologic glucocorticoid replacement therapy. A decision to undergo gastric bypass surgery is based on many individual factors and careful consideration of risks versus benefits. There is nothing specific about Cushing’s that factors into the decision if a sufficient period of time has passed without cortisol excess to make sure that there is no hypercortisolemia or too much cortisol replacement. However, patients who are surgically adrenally insufficient must have very careful monitoring and glucocorticoid replacement in the peri-operative period as surgical stress will require higher steroid doses. In addition, other causes of failure to lose weight must be excluded. In patients, for example, who have had pituitary surgery or radiation therapy it is important to make certain that hypothyroidism is not contributing to weight gain, or, lack of weight loss. In addition, in patients who do have bariatric surgery, doses of medications may need to be adjusted because of changes in weight and absorption so this should be addressed by the treating physician as well.

By Dr. Anne Klibanski MD (Winter, 2009)