Diabetes and weight gain after bariatric surgery, due to Cushing’s syndrome
E.A.R, 45 yrs. old, female, referred to our Service in 2013, due to the presence of
a tumor in right adrenal discovered in abdominal TC. This exam was realized as a routine
AFTER bariatric surgery (BS) in 2004. She told us that she lost 40 Kg after surgery.
However, in 6 months her weight gained 20Kg with no clear reason. Increased blood
pressure and hyperglycemia appeared. She related pain in limbs, alopecy and amenorrheia,
a year ago. In use of: Losartan 100mg/day, Spironolactone 200mg/day, Carvedilol 25mg/day,
Aspirin 100mg/day, Simvastatin 20mg/day, Omeprazol 20mg/day, Furosemide 40mg/day.
Physical exam: Weight: 89Kg, heigh: 1,58m, BMI: 35,6Kg/m2, WC: 116cm, Blood pressure: 200x120mmHg, HR: 104bpm. Proximal muscle weakness, abdominal
striae, moon face, hump back, blurred vision, neurological, musculoskeletal, skin
and hearing alterations. Results: A1c: 8%( N5.7), TSH: 0,7mUI/L (N: 0,3-4,2), ACTH:
18,8pg/mL (N: 7,2-63,3), basal cortisol: 24,5mcgmL (N: 7-28), Aldosterone: 7ng/dl(4-31),
androstenidione: 1,5ng/dl (N: 0,8-4,4), catecolamins: 319mcg/24hs (N: 190-450), urinary
cortisol: 1089mcg/24hs(N: 10-90), DHEA: 15mmol/L (N: 0,7-6,75), estradiol: 19,6ng/dl
(N: 3), renine: 4,9ng/mL/h (up, N: 1,5-5,7), testosterone total: 12pgmL (N: 0,3-2,5),
FSH: 11mUImL (menopause N: 30), LH: 12,1mUImL (N: 15), prolactin: 10,3mcg/L (N:
2-15), supression test after 1mg of dexamethasone-cortisol: 22,48mcg/dl (N1,8).
We started Metformin 1700mg/day, Cetoconazol 800mg/dia and Insulin NPH 40UI/day. Referred
to surgery.