Endocrine Abstracts

Introduction: Bariatric surgery is a revolutionary method for the treatment of morbid obesity. It is effective as far as weight control is concerned, for the prevention and treatment of diabetes mellitus and the metabolic syndrome. However, bariatric surgery may be accompanied by adverse effects if postoperatively dietary instructions are not adhered to.

Aim: The aim was to present a case of a patient who underwent sleeve gastrectomy for the treatment of morbid obesity and postoperatively developed severe malabsorption and vitamin D deficiency.

Methods: The case of a patient, female, aged 50 is described, who suffered from morbid obesity, body weight being 250 kg, BMI 91.83. The patient underwent sleeve gastrectomy, the treatment being effective as far as weight loss is concerned, as she lost weight. However, in the course of the disease the patient did not comply with dietary instructions. She developed diarrhea, severe malabsorption, severe vitamin D deficiency and spontaneous rib fractures. Additionally, she developed hidradenitis suppurativa.

Results: An intestinal biopsy was performed which showed non-specific intestinal inflammation. However, the syndrome of diarrhea was so severe, that mesalazine was administered. Mesalazine administration improved diarrhea. A month ago, the patient presented with generalized bone and muscle pain, cardiac insufficiency and respiratory insufficiency. Plasma 25(OH)D₃ was 3 ng/ml (normal range >30 ng/ml), PTH 280 pg/ml (normal range 10–65 pg/ml) and plasma calcium 8.4 mg/dl. Cholecalciferol was administered in high dosage and generalized pain improved.

Conclusions: Morbid obesity may be a manifestation of severe depression, which affects dietary behavior and may manifest as bulimia. Surgical treatment of obesity improves body weight however it does not improve depression. Dietary behavior may persist with destructive effects on the gastrointestinal system and the organism, such as premature ageing, diarrhea and malabsorption with vitamin and micronutrient deficiency. In particular vitamin D deficiency may induce osteomalacia and generalized bone and muscle pain. In the case described, the patient developed hidradenitis suppurativa, which, being an autoimmune disorder, may have been partially induced by vitamin D deficiency.