Adrenal insufficiency following bariatric surgery

Abstract

A 35-year-old woman with morbid obesity and amenorrhoea underwent a bilo-pancreatic diversion (BPD). Surgery was successful with good weight loss, restoration of menstruation and almost immediately she conceived for the first time. She was commenced on routine vitamin supplements after surgery but failed to attend follow-up clinic. Five years later, she presented with limb girdle pains, lethargy, night blindness, skin pigmentation, amenorrhoea and dizziness. She had stopped taking supplements prescribed after the surgery. Investigations showed severe vitamin A and D deficiency along with iron and calcium deficiency. Her cholesterol was low at 3.5 mmol L⁻¹. Despite aggressive vitamin replacement, she continued to complain of lethargy and dizziness. Subsequently, three short adrenocorticotropic hormone-stimulation tests were suboptimal (basal cortisol: 196, 185 and 223 nmol L⁻¹; 30 min cortisol: 421, 453 and 435 nmol L⁻¹). She was subsequently commenced on adrenal replacement and her symptoms resolved and she conceived. We describe for the first time in the literature the unexpected finding of adrenal insufficiency following a BPD.

Dermatological manifestations relating to nutritional deficiencies after bariatric surgery: case report and integrative literature review

“…77,87 As demonstrated in Table 1, among the 41 patients selected, 27 had systemic manifestations and these were potentially fatal or fatal in 11 patients. 37,41,43,[46][47]49,50,61,65,67 Although not the purpose of this review, it is also necessary to consider that there are cutaneous manifestations that occur after bariatric surgery, which are not due to nutritional deficiency. On the contrary, these are due to excessive replacement of micronutrients, a situation seen with relative frequency in patients in the late postoperative period of bariatric surgery.…”