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Impaired dexamethasone resorption in two patients with pseudo-Cushing after bariatric surgery: Implications for immunosuppressive treatment.

Authors
  • Humpert, Per M1
  • Samigullin, Azat1
  • Lindner, Andre2
  • Weihrauch, Julia1
  • Oikonomou, Dimitrios1
  • Metzner, Cornelia1
  • Böttcher, Knut A2
  • Morcos, Michael1
  • 1 Stoffwechselzentrum Rhein-Pfalz, Mannheim, Germany. , (Germany)
  • 2 Department of General and Bariatric Surgery, Diakonissenkrankenhaus Mannheim, Mannheim, Germany. , (Germany)
Type
Published Article
Journal
Clinical obesity
Publication Date
Oct 01, 2020
Volume
10
Issue
5
Identifiers
DOI: 10.1111/cob.12383
PMID: 32533634
Source
Medline
Keywords
Language
English
License
Unknown

Abstract

Two cases of middle-aged female patients treated by gastric bypass surgery for weight loss presented to our clinic for a follow-up examination 3-6 months after the surgical procedure (a mini gastric bypass and a modified single anastomosis sleeve-ileostomy). In both patients increased ACTH levels and either high serum cortisol or an increased urinary cortisol excretion was apparent and triggered further endocrine testing. Serum cortisol could not be suppressed adequately by 2 and 4 mg dexamethasone in the standardized oral overnight suppression test while midnight salivary cortisol dropped well below the desired cut-off. This led to the hypothesis of an impaired dexamethasone resorption and could be further substantiated by suppression of serum cortisol below the cut-off by an intravenous dexamethasone application. The data presented point to an impairment of enteral synthetic corticosteroid resorption in patients after gastric bypass surgery and could be of importance for individuals in need for immunosuppressive treatment. In view of the growing number of bariatric procedures, pharmacokinetics of corticosteroids and other drugs should be tested in clinical trials. © 2020 World Obesity Federation.

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