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Prevalence of Endocrine Disorders in Morbidly Obese Patients and the Effects of Bariatric Surgery on Endocrine and Metabolic Parameters

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Abstract

Background

Several endocrine abnormalities, including hypothyroidism and Cushing’s syndrome (CS), are considered as causative factors of obesity. The aim of this study was to evaluate the prevalence of endocrine disorders and obesity-associated co-morbidities, as well as the impact of substantial weight loss.

Methods

Screening was performed in 433 consecutive morbidly obese patients (age 41 ± 12 years; BMI 47 ± 6.9 kg/m2; women 76%). A 1-mg dexamethasone suppression test (1-mg DST) was conducted to exclude CS, and thyrotropin (TSH) was measured to exclude hypothyroidism. Insulin sensitivity was estimated from oral glucose tolerance tests employing the Clamp-like index. Examinations were carried out at baseline, as well as at 6 and 12 months postoperatively.

Results

The prevalence of CS was below 0.6%. Before surgery, TSH was elevated compared to an age- and sex-matched normal weight control group (2.4 ± 1.2 vs. 1.5 ± 0.7 μU/ml; p < 0.001). The NCEP criteria of metabolic syndrome (MetS) were fulfilled by 39.5% of the patients. Impaired glucose tolerance and diabetes mellitus were observed in 23.5% and 22.6%, respectively. Seventy-two percent were insulin resistant. During follow-up, weight (BMI 47 ± 6.9 vs. 36 ± 6.4 vs. 32 ± 6.6 kg/m2; p < 0.001) and TSH decreased significantly (2.4 ± 1.2 vs. 1.8 ± 1.0 vs. 1.8 ± 1.0 μU/ml; p < 0.001). Serum cortisol was higher in the MetS+-group compared to the MetS--group (15.0 ± 6.3 vs. 13.5 ± 6.3 μg/dl; p = 0.003).

Conclusions

CS appears to be a rare cause of morbid obesity. Normalization of slightly elevated thyrotropin after weight loss suggests that obesity causes TSH elevation rather than the reverse.

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Conflict of interest disclosure

DJ, PW, CHA, YW, MPS, AH, FL, GP, BL, AG, AL and MK declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research reported.

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Authors and Affiliations

  1. Division of Endocrinology and Metabolism, Department of Internal Medicine III, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria

    Draženka Janković, Peter Wolf, Christian-Heinz Anderwald, Yvonne Winhofer, Miriam Promintzer-Schifferl, Astrid Hofer, Bernhard Ludvik, Alois Gessl, Anton Luger & Michael Krebs

  2. Division of Surgery, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria

    Felix Langer & Gerhard Prager

  3. Metabolic Unit, Istituto di Ingegneria Biomedica-Consiglio Nazionale delle Ricerche (ISIB-CNR), Corso Stati Uniti 4, 35127, Padua, Italy

    Christian-Heinz Anderwald

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  1. Draženka Janković
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Correspondence to Michael Krebs.

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Janković, D., Wolf, P., Anderwald, CH. et al. Prevalence of Endocrine Disorders in Morbidly Obese Patients and the Effects of Bariatric Surgery on Endocrine and Metabolic Parameters. OBES SURG 22, 62–69 (2012). https://doi.org/10.1007/s11695-011-0545-4

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