Exp Clin Endocrinol Diabetes 2014; 122 - P048
DOI: 10.1055/s-0034-1372065

59 year old woman after a bariatric procedure with obesity and hypoglycemia – a case report

JP Kacperczyk 1, J Orlewski 1, PJ Bartnik 1, D Kaczmarska-Turek 2, T Bednarczuk 2
  • 1Medical University of Warsaw, Students' Scientific Group, Chair and Department of Internal Medicine and Endocrinology, Warsaw, Poland
  • 2Medical University of Warsaw, Chair and Department of Internal Medicine and Endocrinology, Warsaw, Poland

Introduction: 59 year old woman with hypertension and obesity was admitted with suspicion of Cushing's syndrome. The patient underwent a bariatric surgery (Conventional Roux-en-Y Gastric Bypass) 3.5 years prior to admission. BMI before the surgery was 56,6 kg/m2. BMI on admission was 39.2 kg/m2. On history taking the patient complained of subsequent gradual weight gain and denied overeating.

Materials and methods: Clinical findings showed pathological obesity. Further diagnostic procedures focused on identifying the cause of extensive weight gain despite the invasive weight loss treatment. There was a strong suspicion of endocrine disorders, especially Cushing's syndrome and insulinoma. Therefore, the oral glucose tolerance test, supervised 72-h fast glucose suppression test, densitometry and abdominal CT scans with intravenously injected contrast agents were performed.

Results: Biochemical and imagining analysis excluded Cushing's syndrome and insulinoma. The OGTT showed 97 mg/dl of glucose at the beginning and 61 mg/dl after two hours. Furthermore, during the OGTT a significantly enhanced (87.8 mIU/ml) insulin action was noted at 60-minute mark followed by a sudden decrease to reference interval (8,27 mIU/ml) during the second hour. The results of suppression tests were questionable due to absence of ketone bodies in urine. CT scans were negative. Densitometry showed osteopenia in L1-L4. In addition, patient's behavior suggested excessive caloric intake during suppression tests, which contradicted the findings on examination. Therefore, mental disorders were suspected.

Discussion: Evaluation of an overweight patient should include clinical and laboratory studies. Due to their results, the type and severity of obesity and health risk can be characterized, which may lead to a therapy selection. Patients after bariatric surgeries should be kept under long-term observation of a group of specialists, including diabetologist, dietitian, surgeon and psychologist.