ECE2023 Poster Presentations Adrenal and Cardiovascular Endocrinology (72 abstracts)
The impact of Bariatric Surgery on the 1mg Dexamethasone Suppression Test in patients with Severe Obesity
Anna Casteràs 1 , Enzamaria Fidilio 1 , Marta Comas 1 , Angel Michael Ortiz 1 , Betina Biagetti 1 , Alba Zabalegui 1 , Francesca Filippi 2,3 , Marina Giralt 2 , Roser Ferrer 2 , Ramon Vilallonga 4 & Andreea Ciudin 1
1Hospital Universitari Vall d’Hebron, Diabetes and Metabolism Research Unit, Vall d’Hebron Institut de Recerca (VHIR), Universitat Autònoma de Barcelona., Endocrinology and Nutrition Department, Barcelona, Spain; 2Hospital Universitari Vall d’Hebron, Department of Biochemistry, Barcelona, Spain; 3Hospital Universitari Vall d’Hebron, Clinical Pharmacology Department, Barcelona, Spain; 4Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Endocrine, Metabolic and Bariatric Unit, General Surgery Department, Barcelona, Spain
Background: The cortisol suppression test with 1 mg dexamethasone (DST) is a screening test for hypercortisolism with high sensitivity (95%) for serum cortisol cut-off <1.8 μg/dl. However, cortisol tests may give false positive in patients with severe obesity (SO). On the other hand, bariatric surgery (BS) is the most effective treatment for SO, and the operated population is growing. At present there is no reliable data regarding the impact of BS on DST results in patients with SO, as well as on the role of the DST as predictor of response to BS. On these bases we performed the present study.
Objectives: a) To explore the impact of BS on the results of the DST. b) To evaluate the impact of cortisol suppression on the response to BS (in terms of weight loss).
Methods: Prospective study including patients with SO scheduled for BS at our site between January-2019 and March-2020. Patients with overt clinical endogenous hypercortisolism or corticosteroid treatment were excluded. All the patients underwent at baseline and 12 months after BS complete medical history, anthropometric data, biochemical analysis and DST.
Results: 23 patients were included, 69.6% females, mean age 44.4±9.3years, BMI 45.97±8.23kg/m2, excess weight (EW) 59.76 ±25.07 kg (according to BMI 25kg/m2). All the patients presented DST <1.8ug/dl before BS, while 1 case had a higher cortisol value after BS. Cortisol after DST was significantly higher 12m post-BS than baseline (0.82 ±0.29ug/dl vs 0.94 ±0,31 ug/dl, P=0.05). There was direct correlation between BMI and DST suppression level at baseline (P<0.01), without any relationship with age, gender, menopausal state or associated comorbidities. Regarding weight response to BS, 11 (47.8%) patients achieved a weight loss of >75% of the EW at 12m. Patients with a suppression of cortisol <0.8 ug/dl were less likely to achieve this threshold (P<0.02, AUC 0.79, S 0.73 and E 0,75) (P= 0.03)
Conclusions: All the patients with SO suppressed cortisol below 1.8 ug/dl in the pre-BS DST. Cortisol after DST increases following BS, and may not suppress properly in some patients. A DST cortisol threshold <0,8 ug/dl before BS predicted a lower weight loss, reaching less than 75% of the EW at 1 year.
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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