Short summary

Central obesity results in a cluster of metabolic abnormalities contributing to premature death, so-called Pseudo-Cushing's syndrome. Glucocorticoids regulate adipose-tissue differentiation, function and distribution, and in excess, cause central obesity. To our knowledge, no studies have reported results on levels of cortisol and testosterone before and after bariatric surgery.

Rationale

Obesity, poor physical fitness and low muscular strength are associated with all-cause mortality. Loss of bodyweight is commonly achieved by diet with or without exercise intervention. However, both diet and diet+exercise programs are often followed by weight regain and it is generally difficult to achieve long-term weight loss. Loss of bodyweight reduces morbidity and mortality. Bariatric surgery is the most effective method to treat severe obesity and type 2 diabetes mellitus achieving high remission rates. However, weight loss also decreases skeletal muscle mass which might counterbalance the positive effects of a bariatric surgery since low lean body mass is linked to increased mortality under various circumstances (i.e., heart disease, cancer, burn injuries). On the other hand, the loss of muscle could merely be a natural adaptation to a lower weight after bariatric surgery. Currently, there are no effective approaches to prevent the immense loss of muscle and bone mass following bariatric surgery although several approaches can be considered, e.g. exercise and dietary intervention. Low testosterone levels have been associated with sarcopenia, insulin resistance, increased body fat, reduced quality of life and loss of libido and sexual function. Testosterone therapy increases lean body mass (i.e. muscle mass), improves bone density and decreases fat mass. As up to 78.8% of patients undergoing bariatric surgery suffer from low testosterone levels, testosterone therapy prior to and after bariatric surgery may prevent or reduce the considerable loss of muscle mass during the weight loss period. So far, no studies have evaluated the effect of testosterone therapy combined with exercise and diet counselling on body composition and quality of life in men undergoing bariatric surgery. Pseudo-Cushing's syndrome Central obesity results in a cluster of metabolic abnormalities contributing to premature death, so-called Pseudo-Cushing's syndrome. Glucocorticoids regulate adipose-tissue differentiation, function and distribution, and in excess, cause central obesity. To our knowledge, no studies have reported results on levels of cortisol and testosterone before and after bariatric surgery. This audit represents an evaluation of clinical practice and offers valuable data on the so-called normal levels of cortisol as a predictor for outcome in obese individuals thus improving the ability to distinguish Pseudo-Cushing from Cushing's syndrome. Objective: To describe gonadal function, cardiovascular risk factors and the association with cortisol levels in patients (men and women) eligible for bariatric surgery.

Description of the cohort

A prospective study (audit) in patients found eligible to bariatric surgery.

Data and biological material

Outcomes: Androgen status, LH, FSH, prolactin, HOMA-IR, T4, ACTH and cortisol levels (blood samples) during an overnight dexamethasone suppression test.

Collaborating researchers and departments

Department of Endocrinology, Odense University Hospital

• Marianne Andersen, MD, Professor, DMSc
• Dorte Glintborg, MD, DMSc
• René Støving, MD, Professor, PhD

The Endocrinology unit and bariatric team, Hospital of Southwest Jutland

• MD, PhD, Jeppe Gram
• MD, PhD, Claus Juhl

Department of Internal Medicine, Hospital of Lillebaelt, Kolding

• MD, PhD, Alin Andries

Department of Clinical Biochemistry, Hospital of Southwest Jutland

Department of Clinical Biochemistry and Pharmacology, Odense University Hospital

OPEN, Odense University Hospital