Impaired dexamethasone resorption in two patients with pseudo‐Cushing after bariatric surgery: Implications for immunosuppressive treatment

Abstract

Summary Two cases of middle‐aged female patients treated by gastric bypass surgery for weight loss presented to our clinic for a follow‐up examination 3‐6 months after the surgical procedure (a mini gastric bypass and a modified single anastomosis sleeve‐ileostomy). In both patients increased ACTH levels and either high serum cortisol or an increased urinary cortisol excretion was apparent and triggered further endocrine testing. Serum cortisol could not be suppressed adequately by 2 and 4 mg dexamethasone in the standardized oral overnight suppression test while midnight salivary cortisol dropped well below the desired cut‐off. This led to the hypothesis of an impaired dexamethasone resorption and could be further substantiated by suppression of serum cortisol below the cut‐off by an intravenous dexamethasone application. The data presented point to an impairment of enteral synthetic corticosteroid resorption in patients after gastric bypass surgery and could be of importance for individuals in need for immunosuppressive treatment. In view of the growing number of bariatric procedures, pharmacokinetics of corticosteroids and other drugs should be tested in clinical trials.

Treatment of COVID-19 Patients Post-Bariatric Surgery: Issues for Consideration

“…Glucocorticoid metabolism is also altered after bariatric surgery [20]. Clinical data are limited to one study, reporting two cases of uncontrolled cortisol levels during oral dexamethasone treatment after bariatric surgery, until dexamethasone was administered intravenously [21]. In addition, steroids may increase the risk of marginal ulcers post-bypass surgery and care should be taken to prevent them.…”