Endocrine Abstracts

We report a case of a 45-year-old gentleman who was seen in the Endocrine Clinic with confirmed phaeochromocytoma. He had a background of obesity; he weighed 123 kg and at a height of 169 cm, his BMI was 43 kg/m². This presented a significant risk for laparoscopic abdominal surgery, general anaesthesia and post operative recovery. He was therefore urgently referred to a Tier 3 Bariatric Service and commenced on subcutaneous injections of Semaglutide, initially 0.25 mg weekly for 4 weeks, followed by 0.5 mg weekly for 4 weeks, which was then increased to 1 mg weekly. He was also referred to the specialist bariatric dietitian for a Very Low Calorie Diet (VLCD) in the form of total meal replacement. His diet consisted of increasing his daily water intake to 3 litres and eating three meal replacement bars (232 kcal each) a day in addition to a portion of vegetables. With this he took a multivitamin and Omega 3 supplements. Of note, the increased water intake helped mitigate any postural hypotension symptoms that are commonly associated with uptitration of phenoxybenzamine. After 4 weeks, he had lost 11 kg and by 12 weeks he had lost 15 kg (12% weight reduction from baseline). However, blood tests showed a microcytic anaemia (haemoglobin 128 g/l) with deficiencies of iron (3 umol/l) and vitamin B12 (149 ng/l). He was subsequently commenced on ferrous fumarate 210 mg twice daily and vitamin B12 intramuscular injections. In view of his micronutrient status, he was advised to increase his daily calorific intake to a total of 1200 kcal with the addition of small meals. After 16 weeks, he underwent a successful left laparoscopic adrenalectomy for definitive treatment of his phaeochromocytoma. The operation was a success with no immediate complications and he was discharged home a couple of days later. He was followed up in clinic after a fortnight, at which point his weight was 105 kg (15% weight reduction from baseline). This case illustrates the results that can be attained through strict adherence to a VLCD in combination with GLP-1 agonist therapy, at the same time as the need to closely monitor for nutritional deficiencies.