Endocrine Abstracts

Introduction: Obesity is a chronic disease which has become a global epidemic. Approximately 7% of deaths per year is associated with obesity, especially because of its complications such as cardiovascular diseases, type 2 diabetes or cancer. Lifestyle interventions are the first line of management but additional pharmacotherapy or bariatric surgery should be considered in more severe cases.

Case report: A 40-year-old woman was referred to Endocrinology Outpatient Clinic because of severe obesity. She underwent laparoscopic sleeve gastrectomy few years ago which led to weight loss. However, a return to unhealthy eating habits as well as an insufficient physical activity, have caused obesity recurrence. The patient has been treated with metformin 1 g because of insulin resistance, perindopril 5 mg due to hypertension and venlafaxine 150 mg because of depression. Despite of metformin implementation, diet and activity interventions, the reduction of weight has not been achieved. At the first endocrinology consultation, the patient had a body weight of 124 kg and a body mass index of 43.97 kg/m². Blood pressure was 137/85 mmHg under treatment. The laboratory tests revealed normal liver and renal function. The pituitary function (corticotropic, thyroid, gonadal, and somatotroph axes) was also confirmed as normal. US abdomen examination showed signs of hepatic steatosis and lack of gall bladder which has been removed due to cholelithiasis. Fasting laboratory test results showed: total cholesterol of 183.0 mg/dl, LDL-cholesterol of 110.2 mg/dl, triglycerides of 109.0 mg/dl, HDL-cholesterol of 51 mg/dl. Oral glucose tolerance test at time 0-60-120 min, after a 2-week break in the use of metformin, revealed glucose levels: 100-278-99 mg/dl and insulin levels 10.8-75.9-18.4 μUI/ml, with mild insulin resistance at fasting (HOMA-IR 2.67). Thus, considering severe obesity, unresponsive to diet and lifestyle interventions, complicated by hypertension, impaired fasting glucose, hepatic steatosis and depression, a GLP1-receptor agonist therapy with liraglutide has been proposed, from a starting dose at 0.6 mg up to a final dose at 3.0 mg per day. No side effects have been registered during therapy so far. At the last follow-up visit, four months after introducing liraglutide, the patients’ weight was 108 kg (BMI 38.29 kg/m²), with a total weight loss of 16 kg (−12.9%).

Conclusions: Liraglutide effectively reduces body weight and may be a safe option of treatment in patients with severe obesity. It should be also considered in subjects with obesity recurrence after bariatric surgery, as an alternative management to reoperation.