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Prevalence of Endocrine Diseases in Morbidly Obese Patients Scheduled for Bariatric Surgery: Beyond Diabetes

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Abstract

Background

Bariatric surgery allows stable body weight reduction in morbidly obese patients. In presurgical evaluation, obesity-related co-morbidities must be considered, and a multidisciplinary approach is recommended. Precise guidelines concerning the endocrinological evaluation to be performed before surgery are not available. The aim of this study was to evaluate the prevalence of common endocrine diseases in a series of obese patients scheduled for bariatric surgery.

Methods

We examined 783 consecutive obese subjects (174 males and 609 females) aged 18–65 years, who turned to the obesity centre of our department from January 2004 to December 2007 for evaluation before bariatric surgery. Thyroid, parathyroid, adrenal and pituitary function was evaluated by measurement of serum hormones. Specific imaging or supplementary diagnostic tests were performed when indicated.

Results

The overall prevalence of endocrine diseases, not including type 2 diabetes mellitus, was 47.4%. The prevalence of primary hypothyroidism was 18.1%; pituitary disease was observed in 1.9%, Cushing syndrome in 0.8%, while other diseases were found in less than 1% of subjects. Remarkably, the prevalence of newly diagnosed endocrine disorders was 16.3%.

Conclusions

A careful endocrinological evaluation of obese subjects scheduled for bariatric surgery may reveal undiagnosed dysfunctions that require specific therapy and/or contraindicate the surgical treatment in a substantial proportion of patients. These results may help to define the extent of the endocrinological screening to be performed in obese patients undergoing bariatric surgery.

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References

  1. Sjöström L, Narbro K, Sjöström CD, et al. Effects of bariatric surgery on mortality in Swedish obese subjects. N Engl J Med. 2007;357:741–52.

    Article  PubMed  Google Scholar 

  2. Adams TD, Gress RE, Smith SC, et al. Long-term mortality after gastric bypass surgery. N Engl J Med. 2007;357:753–61.

    Article  CAS  PubMed  Google Scholar 

  3. Busetto L, Mirabelli D, Petroni ML, et al. Comparative long-term mortality after laparoscopic adjustable gastric banding versus nonsurgical controls. Surg Obes Relat Dis. 2007;3:496–502.

    Article  PubMed  Google Scholar 

  4. Buchwald H, Estok R, Fahrbach K, et al. Weight and type 2 diabetes after bariatric surgery: systematic review and meta-analysis. Am J Med. 2009;122:248–56.

    Article  PubMed  Google Scholar 

  5. Longitudinal Assessment of Bariatric Surgery (LABS) Consortium, Flum DR, Belle SH, King WC, et al. Perioperative safety in the longitudinal assessment of bariatric surgery. N Engl J Med. 2009;361:445–54.

    Article  PubMed  Google Scholar 

  6. Pories WJ. Bariatric surgery: risks and rewards. J Clin Endocrinol Metab. 2008;93:S89–96.

    Article  CAS  PubMed  Google Scholar 

  7. Apovian CM, Cummings S, Anderson W, et al. Best practice updates for multidisciplinary care in weight loss surgery. Obesity. 2009;17:871–79.

    Article  PubMed  Google Scholar 

  8. Fried M, Hainer V, Basdevant A, et al. Inter-disciplinary European guidelines on surgery of severe obesity. Int J Obes. 2007;31:569–77.

    CAS  Google Scholar 

  9. Mechanick JI, Kushner RF, Sugerman HJ, et al. American Association of Clinical Endocrinologists; Obesity Society; American Society for Metabolic & Bariatric Surgery American Association of Clinical Endocrinologists, The Obesity Society, and American Society for Metabolic & Bariatric Surgery medical guidelines for clinical practice for the perioperative nutritional, metabolic, and nonsurgical support of the bariatric surgery patient. Obesity. 2009;17:S1–70.

    Article  PubMed  Google Scholar 

  10. American Heart Association Obesity Committee of Council on Nutrition, Physical Activity and Metabolism, Council on Cardiopulmonary Perioperative and Critical Care, Council on Cardiovascular Surgery and Anesthesia, Council on Cardiovascular Disease in the Young, Council on Cardiovascular Nursing, and Council on Clinical Cardiology, Poirier P, Alpert MA, Fleisher LA, et al. Cardiovascular evaluation and management of severely obese patients undergoing surgery: a science advisory from the American Heart Association. Circulation. 2009;120:86–95.

    Article  PubMed  Google Scholar 

  11. Stocker DJ. Management of the bariatric surgery patient. Endocrinol Metab Clin N Am. 2003;32:437–57.

    Article  Google Scholar 

  12. DeMaria EJ. Bariatric surgery for morbid obesity. N Engl J Med. 2007;356:2176–183.

    Article  CAS  PubMed  Google Scholar 

  13. Caviezel F, Cuzzolaro M, Dalle Grave R, et al. LiGIO’99 “Linee guida italiane obesità”. Bologna, Italy: Pendragon; 1999.

    Google Scholar 

  14. American Diabetes Association. Diagnosis and classification of diabetes mellitus. Diabetes Care. 2008;31(1):S55–60.

    Article  Google Scholar 

  15. Holick MF. Vitamin D deficiency. N Engl J Med. 2007;357:266–81.

    Article  CAS  PubMed  Google Scholar 

  16. Smith TP, Kavanagh L, Healy ML, et al. Technology insight: measuring prolactin in clinical samples. Nat Clin Pract Endocrinol Metab. 2007;3:279–89.

    Article  CAS  PubMed  Google Scholar 

  17. Rago T, Bencivelli W, Scutari M, et al. The newly developed three-dimensional (3D) and two-dimensional (2D) thyroid ultrasound are strongly correlated, but 2D overestimates thyroid volume in the presence of nodules. J Endocrinol Invest. 2006;29:423–26.

    CAS  PubMed  Google Scholar 

  18. Aghini-Lombardi F, Antonangeli L, Martino E, et al. The spectrum of thyroid disorders in an iodine-deficient community: the Pescopagano Survey. J Clin Endocrinol Metab. 1999;84:561–66.

    Article  CAS  PubMed  Google Scholar 

  19. Baloch Z, Carayon P, Conte-Devolx B, Guidelines Committee, National Academy of Clinical Biochemistry, et al. Laboratory medicine practice guidelines. Laboratory support for the diagnosis and monitoring of thyroid disease. Thyroid. 2003;13(1):3–126.

    Article  PubMed  Google Scholar 

  20. Ness-Abramof R, Nabriski D, Apovian CM, et al. Overnight dexamethasone suppression test: a reliable screen for Cushing's syndrome in the obese. Obes Res. 2002;10:1217–21.

    Article  CAS  PubMed  Google Scholar 

  21. Bilezikian JP, Potts JT, Gel-H F, et al. Summary statement from a workshop on asymptomatic primary hyperparathyroidism: a perspective for the 21st century. J Clin Endocrinol Metab. 2002;87:5353–61.

    Article  CAS  PubMed  Google Scholar 

  22. Kelly JJ, Shikora S, Jones DB, et al. Best practice updates for surgical care in weight loss surgery. Obesity. 2009;17:863–70.

    Article  PubMed  Google Scholar 

  23. Greenberg I, Sogg S, Perna FM. Behavioral and psychological care in weight loss surgery: best practice update. Obesity. 2009;17:880–84.

    Article  PubMed  Google Scholar 

  24. Schumann R, Jones SB, Cooper B, et al. Update on best practice recommendations for anesthetic perioperative care and pain management in weight loss surgery, 2004–2007. Obesity. 2009;17:889–94.

    Article  PubMed  Google Scholar 

  25. Raftopoulos Y, Gagné DJ, Papasavas P, et al. Improvement of hypothyroidism after laparoscopic Roux-en-Y gastric bypass for morbid obesity. Obes Surg. 2004;14:509–13.

    Article  PubMed  Google Scholar 

  26. Szomstein S, Avital S, Brasesco O, et al. Laparoscopic gastric bypass in patients on thyroid replacement therapy for subnormal thyroid function—prevalence and short-term outcome. Obes Surg. 2004;14:95–7.

    Article  PubMed  Google Scholar 

  27. Michalaki MA, Vagenakis AG, Leonardou AS, et al. Thyroid function in human with morbid obesity. Thyroid. 2006;16:73–8.

    Article  CAS  PubMed  Google Scholar 

  28. Rotondi M, Leporati P, La Manna A, et al. Raised serum TSH levels in patients with morbid obesity: is it enough to diagnose subclinical hypothyroidism? Eur J Endocrinol. 2009;160:403–8.

    Article  CAS  PubMed  Google Scholar 

  29. Newell-Price J, Bertagna X, Grossman AB, et al. Cushing's syndrome. Lancet. 2006;367:1605–17.

    Article  CAS  PubMed  Google Scholar 

  30. Leibowitz G, Tsur A, Chayen SD, et al. Pre-clinical Cushing’s syndrome: an unexpected frequent cause of poor glycaemic control in obese diabetic patients. Clinic Endocrinol. 1996;44:717–22.

    Article  CAS  Google Scholar 

  31. Catargi B, Rigalleau V, Poussin A, et al. Occult Cushing’s syndrome in type-2 diabetes. J Clin Endocrinol Metab. 2003;88:5808–13.

    Article  CAS  PubMed  Google Scholar 

  32. Newsome S, Chen K, Hoang J, et al. Cushing’s syndrome in a clinic population with diabetes. Intern Med J. 2007;38:178–82.

    Article  PubMed  Google Scholar 

  33. Baid SK, Rubino D, Sinaii N, et al. Specificity of screening tests for Cushing’s syndrome in an overweight and obese population. J Clin Endocrinol Metab. 2009;94:3857–64.

    Article  CAS  PubMed  Google Scholar 

  34. Adami S, Marcocci C, Gatti D. Epidemiology of primary hyperparathyroidism in Europe. J Bone Miner Res. 2002;17:N18–23.

    PubMed  Google Scholar 

  35. Fraser WD. Hyperparathyroidism. Lancet. 2009;374:145–58.

    Article  CAS  PubMed  Google Scholar 

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Funding

This work was supported by Ministero dell’Università e della Ricerca, Programmi di Ricerca Scientifica 2007 “Pathogenic mechanisms determining the obese phenotype and influencing the response to treatment”, Ministero dellla Salute, Programmi di Ricerca Finalizzata 2006 “Integrate protocols for the prevention and the treatment of obesity”.

Conflict of interest

PF, AP, SM, GS, GS, MG, AP, GG, IR, TR, CD, MA, PV and FS declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of research reported.

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Authors and Affiliations

  1. Department of Endocrinology and Kidney, University Hospital of Pisa, Via Paradisa 2, Pisa, 56124, Italy

    Paola Fierabracci, Aldo Pinchera, Silvia Martinelli, Giovanna Scartabelli, Guido Salvetti, Monica Giannetti, Andrea Pucci, Giulia Galli, Ilaria Ricco, Giorgia Querci, Teresa Rago, Paolo Vitti & Ferruccio Santini

  2. Bariatric Surgery Unit, University Hospital of Pisa, Pisa, Italy

    Claudio Di Salvo & Marco Anselmino

Authors
  1. Paola Fierabracci
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  2. Aldo Pinchera
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  3. Silvia Martinelli
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  4. Giovanna Scartabelli
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  5. Guido Salvetti
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  6. Monica Giannetti
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  7. Andrea Pucci
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  8. Giulia Galli
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  9. Ilaria Ricco
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  10. Giorgia Querci
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  11. Teresa Rago
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  12. Claudio Di Salvo
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  13. Marco Anselmino
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  14. Paolo Vitti
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  15. Ferruccio Santini
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Corresponding author

Correspondence to Paola Fierabracci.

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Fierabracci, P., Pinchera, A., Martinelli, S. et al. Prevalence of Endocrine Diseases in Morbidly Obese Patients Scheduled for Bariatric Surgery: Beyond Diabetes. OBES SURG 21, 54–60 (2011). https://doi.org/10.1007/s11695-010-0297-6

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  • DOI: https://doi.org/10.1007/s11695-010-0297-6

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