Is screening for Cushing's syndrome before bariatric surgery necessary?

Yıl 2020, , 529 - 533, 18.09.2020

Mehmet Sercan Ertürk , Mehmet Celik , Mehmet Nuri Koşar

https://doi.org/10.31362/patd.694115

Öz

Purpose:
Recent studies have shown a higher prevalence of Cushing's syndrome in obese
patients with type 2 diabetes, but its prevalence in overweight and obese
populations is not clear. The aim of this study was to evaluate the need for
screening tests for Cushing's syndrome in morbidly obese individuals before
bariatric surgery.

Materials and methods: Between January 2015 and December 2019, 300 patients
with Body Mass Index (BMI) ≥35 kg/m² that admitted to our endocrine
outpatient clinic for evaluation before bariatric surgery were included in this
study. Overnight low dose 1 mg dexamethasone suppression test was applied to
all patients. Next day 8 am serum cortisol concentration less than 1.8 μg/dL
was defined as normal suppression.

Results: Three hundred patients undergoing
bariatric surgery were screened for Cushing's syndrome. The mean±standard deviation age of the patients was 39.4±11.7
years and 236 (77.3%) were women. The mean BMI of the patients was 45.9±5.5
kg/m² before bariatric surgery. Forty-seven (15.7%) patients in type
2 diabetes mellitus, 28 (9.3%) patients with hypertension and 3 (1%) patients
who had achived euthyroidism after levothyroxine treatment. The mean one year
BMI after bariatric surgery was 28±4.6 kg/m². Serum cortisol
concentration was <1.8 μg/dL after 1 mg overnight dexamethasone suppression
test in all patients.

Conclusion: The results of the evaluated
data  revealed that the routine screening
of morbidly obese individuals for Cushing's syndrome before bariatric surgery
is not necessary.

Anahtar Kelimeler

Obesity, Bariatric Surgery, Cushing's syndrome, dexamethasone suppression test

Bariatrik cerrahi öncesi Cushing sendromu için tarama testi gerekli midir?

Öz

Amaç: Son çalışmalar diyabeti bulunan obez
hastalarda Cushing sendromu prevalansının daha yüksek olduğunu göstermiştir,
ancak aşırı kilolu ve obez popülasyonlardaki prevalansı net değildir. Bu
çalışmanın amacı, bariatrik cerrahi öncesi morbid obez bireylerde Cushing
sendromu için tarama testlerine duyulan ihtiyacı değerlendirmektir.

Gereç ve yöntem: Ocak 2015-Aralık 2019 tarihleri
​​arasında bariatrik cerrahi öncesi değerlendirme için endokrin polikliniğimize
başvuran Vücut Kitle İndeksi (VKİ) ≥ 35 kg/m² olan 300
hasta çalışmaya dahil edildi. Tüm hastalara gece 23:00’de  düşük doz 1 mg deksametazon supresyon testi
uygulandı. Ertesi gün sabah serum kortizol konsantrasyonu 1,8 μg/dL'den az
olması normal supresyon olarak tanımlandı.

Bulgular: Bariatrik cerrahi geçiren 300 hasta
Cushing sendromu açısından tarandı. Hastaların yaşı 39,4±11,7 yıl ve %77,3'ü kadındı.
Bariatrik cerrahi öncesi hastaların ortalama VKİ'si 45,9±5,5 kg/m² idi. Tip
2 diyabetli 47 (%15,7) hasta, hipertansif olan 28 (%9,3) hasta ve hipotiroidi
tedavisi sonrası ötiroidi ile takip edilen 3 (%1) hasta olduğu saptandı.
Bariatrik cerrahi sonrası ortalama 1 yıllık VKİ 28±4,6 kg/m² idi. Tüm hastalarda 1 gecelik 1 mg deksametazon
supresyon testinden sonra serum kortizol konsantrasyonu <1,8 μg/dL idi.

Sonuç: Çalışmamızda değerlendirilen
verilerin sonuçları, morbid obez bireylerin bariatrik cerrahi öncesi Cushing
sendromu için rutin olarak taranmasının gerekli olmadığını göstermiştir.

Anahtar Kelimeler

Obezite, Bariatrik Cerrahi, Cushing sendromu, deksametazon supresyon testi

Kaynakça

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