Is screening for Cushing's syndrome before bariatric surgery necessary?

Abstract

Purpose: Recent studies have shown a higher prevalence of Cushing's syndrome in obese patients with type 2 diabetes, but its prevalence in overweight and obese populations is not clear. The aim of this study was to evaluate the need for screening tests for Cushing's syndrome in morbidly obese individuals before bariatric surgery.

Materials and methods: Between January 2015 and December 2019, 300 patients with Body Mass Index (BMI) ≥35 kg/m² that admitted to our endocrine outpatient clinic for evaluation before bariatric surgery were included in this study. Overnight low dose 1 mg dexamethasone suppression test was applied to all patients. Next day 8 am serum cortisol concentration less than 1.8 μg/dL was defined as normal suppression.

Results: Three hundred patients undergoing bariatric surgery were screened for Cushing's syndrome. The mean±standard deviation age of the patients was 39.4±11.7 years and 236 (77.3%) were women. The mean BMI of the patients was 45.9±5.5 kg/m² before bariatric surgery. Forty-seven (15.7%) patients in type 2 diabetes mellitus, 28 (9.3%) patients with hypertension and 3 (1%) patients who had achived euthyroidism after levothyroxine treatment. The mean one year BMI after bariatric surgery was 28±4.6 kg/m². Serum cortisol concentration was <1.8 μg/dL after 1 mg overnight dexamethasone suppression test in all patients.

Conclusion: The results of the evaluated data  revealed that the routine screening of morbidly obese individuals for Cushing's syndrome before bariatric surgery is not necessary.

Keywords

• Obesity
• Bariatric Surgery
• Cushing's syndrome
• dexamethasone suppression test

Bariatrik cerrahi öncesi Cushing sendromu için tarama testi gerekli midir?

Öz

Amaç: Son çalışmalar diyabeti bulunan obez hastalarda Cushing sendromu prevalansının daha yüksek olduğunu göstermiştir, ancak aşırı kilolu ve obez popülasyonlardaki prevalansı net değildir. Bu çalışmanın amacı, bariatrik cerrahi öncesi morbid obez bireylerde Cushing sendromu için tarama testlerine duyulan ihtiyacı değerlendirmektir.

Gereç ve yöntem: Ocak 2015-Aralık 2019 tarihleri ​​arasında bariatrik cerrahi öncesi değerlendirme için endokrin polikliniğimize başvuran Vücut Kitle İndeksi (VKİ) ≥ 35 kg/m² olan 300 hasta çalışmaya dahil edildi. Tüm hastalara gece 23:00’de  düşük doz 1 mg deksametazon supresyon testi uygulandı. Ertesi gün sabah serum kortizol konsantrasyonu 1,8 μg/dL'den az olması normal supresyon olarak tanımlandı.

Bulgular: Bariatrik cerrahi geçiren 300 hasta Cushing sendromu açısından tarandı. Hastaların yaşı 39,4±11,7 yıl ve %77,3'ü kadındı. Bariatrik cerrahi öncesi hastaların ortalama VKİ'si 45,9±5,5 kg/m² idi. Tip 2 diyabetli 47 (%15,7) hasta, hipertansif olan 28 (%9,3) hasta ve hipotiroidi tedavisi sonrası ötiroidi ile takip edilen 3 (%1) hasta olduğu saptandı. Bariatrik cerrahi sonrası ortalama 1 yıllık VKİ 28±4,6 kg/m² idi. Tüm hastalarda 1 gecelik 1 mg deksametazon supresyon testinden sonra serum kortizol konsantrasyonu <1,8 μg/dL idi.

Sonuç: Çalışmamızda değerlendirilen verilerin sonuçları, morbid obez bireylerin bariatrik cerrahi öncesi Cushing sendromu için rutin olarak taranmasının gerekli olmadığını göstermiştir.

Anahtar Kelimeler

• Obezite
• Bariatrik Cerrahi
• Cushing sendromu
• deksametazon supresyon testi

Kaynakça

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