Endocrine Abstracts

Bariatric surgery is increasingly deployed world-wide in patients with significant weight excess in order to mitigate the deleterious effects of associated metabolic and cardiovascular comorbidities. Pre-operative evaluation systematically investigates for possible causes of secondary obesity due to endocrine pathologies. In our hospital a standard blood test panel comprising the anterior hypophysis, the adrenal and the thyroid is requested as well as an endocrinological evaluation thereafter. We report the case of a 39-year old male patient with morbid obesity and relatively new-onset diabetes and hypertension. At the time of presentation (October 2020), he weighed 128 kg at a height of 173 cm, BMI 42.7 kg/m². The patient reported a weight gain of 37 kg during first half of 2020. The same year he was diagnosed with hypertension and a worsening of his diabetes. The hormonal profile revealed a cortisol in the normal range (212 nmol/l), a suppressed ACTH (1.7 ng/l), all other hormonal axes were in the normal range. A redo analysis confirmed the initial findings and at that moment the patient remembered being investigated several years ago for an adrenal mass, with unclear hormonal profile at the time but labelled as incidentaloma, hence probably hormonally inactive. An abdominal CT-scan in December 2020 demonstrated a mass in the left adrenal gland. Furthermore, both the low dose and the high dose dexamethasone suppression test showed no effect on the morning cortisol level (311 nmol/l and 375 nmol/l, respectively). A diagnosis of adrenal Cushing was established and the patient was referred for surgery. The mass was laparoscopically removed and the histological examination demonstrated a benign adenoma. Post-surgery a substitutive therapy with hydrocortisone adapted for the weight was instituted and an endocrinological follow-up was organized. No data concerning the weight curve at the time of writing this abstract was available. The current case emphasizes the importance of screening all candidates for weight-loss surgery for endocrinological cases of obesity as the therapeutic approach radically changes and missing a curable endocrinological cause may complicates the evolution post-surgery and hinders the results in terms of weight loss. The particularity of this case is the fact that the existence of the adrenal mass was already known but somehow flew under the radar all the while the predisposition to progress to a secretory state is well described in the medical literature.