Short summary

This study investigates how bariatric surgery affects cortisol metabolism and whether changes in cortisol metabolism are associated with reactive hypoglycemia. In a cross-sectional design, 100 participants ≥12 months post-surgery undergo hormone testing, continuous glucose monitoring, and a meal test to explore associations between cortisol response and post-bariatric hypoglycemia.

Rationale

Background and Aim This project investigates how bariatric surgery affects cortisol metabolism and whether altered cortisol response contributes to post-bariatric hypoglycemia (PBH). We aim to test the hypothesis: Patients with and without PBH have different cortisol metabolism profiles. The prevalence of severe obesity is rising globally and is associated with increased morbidity and mortality. Bariatric surgery is currently the most effective treatment, resulting in 30-35% weight loss and significant improvement in obesity-related conditions such as type 2 diabetes, hypertension, and sleep apnea. While many metabolic and hormonal changes after surgery are well documented, few studies have examined how cortisol metabolism is affected. Cortisol is a counter-regulatory hormone during hypoglycemia. PBH is among the most disabling complications post-surgery, yet its frequency varies widely in reports-from 0.4% to 75%. Some studies have shown a reduced cortisol response to hypoglycemia in post-bariatric patients, which could impair the body's ability to counteract low blood sugar. Since cortisol release is normally triggered when blood glucose drops below ~3.1 mmol/L, a blunted response may worsen PBH symptoms. The primary objective is to explore the role of cortisol and its metabolism in the pathophysiology of PBH. This study may lead to improved diagnosis, prognosis, and treatment of PBH.

Description of the cohort

Inclusion Criteria: • Individuals ≥12 months post Roux-en-Y gastric bypass or gastric sleeve surgery. Exclusion Criteria: • Pregnancy or breastfeeding • Nephrotic syndrome, liver cirrhosis, or severe malnutrition (due to low cortisol-binding globulin) • Use of glucocorticoid, opiod or estrogen-containing medications • Known adrenal disorders affecting cortisol metabolism (e.g., adrenal insufficiency, autonomous cortisol production, Cushing's syndrome) • Diabetes requiring medication beyond dietary management

Data and biological material

Blood, saliva, urine, hypoglycemia questionaire, continous glucose measuring,

Collaborating researchers and departments

Department of Endocrinology, OUH

• Marianne Skovsager Andersen
• René Klinkby Støving
• Dorte Glintborg

Steno Diabetes Center OUH

Department of Biochemistry, Vejle Hospital

• Anne Vibeke Smedes

Department of Biochemistry, Esbjerg Hospital

• Gunhild Brixen Nielsen