Obese Patients Don’t Need Cushing’s Screenings Prior to Weight-loss Surgery

Since morbid obesity by itself is not a telltale sign of Cushing’s syndrome, routine screenings for the disease in obese patients referred for weight-loss surgery is unnecessary, a study reported.

Published in the journal Pamukkale Tıp Dergisi, the study was titled “Is screening for Cushing’s syndrome before bariatric surgery necessary?”

Although recent studies have shown that Cushing’s tends to be more prevalent in obese individuals who also have type 2 diabetes, its incidence is still unclear in people who are overweight and obese.

Current guidelines only recommend that obese patients waiting to undergo weight-loss surgery undergo screenings for Cushing’s if they show any signs of the disorder. Such screenings include a urine analysis to measure urine cortisol levels.

Here, a team of Turkish researchers reported the findings of a study that sought to determine if screenings for Cushing’s syndrome should be performed in obese patients before they undergo bariatric surgery. Bariatric surgery includes gastric bypass and other weight-loss surgeries.

To tackle this question, the team examined the medical records of 300 obese patients with a body mass index (BMI) greater than 35 kilograms per meter square (kg/m²). Of note, the normal range 18.5—24.9 kg/m². These individuals had been admitted to an endocrine outpatient clinic between January 2015 and December 2019 to be evaluated before undergoing weight-loss surgery.

All patients included in the analyses completed the overnight dexamethasone suppression test (ODST). That screening test measures the levels of cortisol found in the blood in the morning after patients take a tablet of dexamethasone, a corticosteroid that normally blocks its production.

Cortisol levels lower than 1.8 micrograms per decilitre (mcg/dL) after taking low-dose dexamethasone were considered normal suppression.

All 300 patients included in the analyses — 236 women and 64 men, with a mean age of 39.4 years — had a BMI greater than 40 kg/m² and were considered morbidly obese before undergoing weight-loss surgery.

A total of 47 (15.7%) of these individuals also had type 2 diabetes, and 28 (9.3%) had high blood pressure (hypertension).

However, none of the patients included in the analyses had blood cortisol levels higher than 1.8 mcg/dL in the morning after having the ODST, confirming that none had Cushing’s.

The patients’ BMI dropped from an average of 45.9 kg/m² before surgery to 28 kg/m² one year after the procedure.

“Our study reveals that morbid obesity alone is not an adequate sign for CS screening before bariatric surgery. It can be concluded that routine screening for CS before bariatric surgery in patients with morbid obesity is unnecessary,” the researchers concluded.