Endocrine Abstracts

Background: Bariatric surgery is considered the most effective tool to manage the growing pandemic of obesity related health disorders. Lack of regular surveillance following bariatric procedures can put patients at risk of developing serious micro-nutritional deficiencies and related complications.

Case report: A 51-year-old lady presented to the bariatric services in 2015 with long standing neurological symptoms including memory and cognitive impairment, agitation, loss of dexterity, clumsiness, headaches, tiredness and poor night vision. She complained of pins and needles affecting her hands and feet. She was vomiting intermittently and complained of steatorrhea. She had undergone a Scopinaro gastric bypass procedure 25 years previously but had not been under regular follow-up and was not taking nutritional supplements. She had undergone a thyroidectomy for Grave’s disease 3 years previously and was on Thyroxine replacement, her pre-operative weight was 160 kg (BMI 51.1) and her current weight was 96.9 kg (BMI 30.9). Prior to this, she had been referred to several specialist services, including gastroenterology, haematology, and dermatology for investigations of these symptoms and had been treated for anxiety and depression. She presented to the neurologists in 2013 who found no neurological deficit on examination. She was thoroughly investigated with imaging including CT and MRI brain, MRI of the spinal cord and EEG and no significant abnormalities were detected. The Cerebral perfusion scan suggested the possibility of early Alzheimer’s disease. The neurologists eventually carried out a nutritional assessment, to include iron, ferritin, folate, vitamin B12, vitamin D and she was found to be severely nutritionally depleted. She was started on iron, vitamin D, vitamin B12 and folate with some improvement in her neurological symptoms. Additional tests through our bariatric service found her to be deficient in vitamin A, Vitamin B12, copper, zinc and selenium. She was replaced with those and maintained on multivitamin replacement with marked improvement of her symptoms of night vision and neuropathy.

This case highlights the importance of life-long nutritional replacement post-bariatric surgery. Malabsorptive Bariatric procedures may affect absorption of several nutrients including fat-soluble vitamins (A, D and E) and other minerals including zinc and copper. If neurological sequelae are present, thiamine, vitamin B12 and copper should be assessed. Malabsorption of thyroxine may also affect thyroxine replacement which needs to be carefully monitored in these patients.