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Long term endocrine issues with Bariatric surgery are an area of active research...
Long term endocrine issues with Bariatric surgery are an area of active research...
In my practice in the last few years, I have come across 2-3 patients who had undergone Roux-en-Y gastric bypass many years back, who were diagnosed to have adrenal insufficiency. All of them had Central adrenal insufficiency.
We dug up some literature on that and found that someone has reported similar cases in the literature. Here is the abstract for the same
https://www.endocrine-abstracts.org/ea/0031/ea0031p232
https://www.endocrine-abstracts.org/ea/0031/ea0031p232
The authors propose possible reasons for adrenal insufficiency post-bariatric surgery as :
a) Resetting of HPA axis
b) Malabsorption of trace elements involved in the metabolism of glucocorticoids
c) Cholesterol malabsorption
d) Possible Pituitary infarct/apoplexy
a) Resetting of HPA axis
b) Malabsorption of trace elements involved in the metabolism of glucocorticoids
c) Cholesterol malabsorption
d) Possible Pituitary infarct/apoplexy
I also believe that sometimes this may be diagnosed late because symptoms of adrenal insufficiency often overlap with features of Bariatric surgery
Weight loss, nausea, vomiting can occur after bariatric surgery, they also are features of Adrenal insufficiency!
We don't know the exact mechanism for the central adrenal insufficiency after bariatric surgery, however, this is something we should look out for, especially if we find that there is no mechanical reason for nausea and vomiting post-surgery.
Also a common thread for all of them was that they underwent RYGB and not other surgeries
And the diagnosis was made several years after the surgery
And the diagnosis was made several years after the surgery
If you have seen similar cases, please do share your views.
