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Endocrine and Metabolic Complications After Bariatric Surgery

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Management of Nutritional and Metabolic Complications of Bariatric Surgery

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Abstract

Overweight and obesity are epidemic around the world. They represent a spectrum of a chronic disease causing physical, metabolic, and psychological derangements that deteriorate health. Adipose tissue may become diseased, a condition called adiposopathy. Adiposopathy includes changes in fat mass (adiposity) along with changes in adipose tissue architecture and function, and the preferential distribution of adipose tissue into some compartments like intra-abdominal (visceral) fat. All of this constitutes the pathophysiology of adipose tissue, and its contribution to this chronic disease. The standard of medical care in 2021 is to aggressively treat adiposopathy, overweight, and obesity. Bariatric surgery should be offered to patients whose disease is truly refractory to medical management with lifestyle changes, medical nutrition therapy, increased physical activity, pharmacotherapy, and non-invasive procedures. Bariatric surgery is not a cure for adiposopathy, overweight, or obesity. Rather, it is effective treatment, and can put them into remission. Bariatric surgery does not change the need to monitor and treat patients for life. Clinicians should be familiar with the risks and benefits of the bariatric procedures available, and the potential complications that may develop from them.

This chapter discusses the metabolic and endocrine changes in adiposopathy, overweight and obesity. It reviews the response of these changes to common bariatric surgeries. Finally, this chapter also addresses the potential endocrine complications of bariatric surgery, and their management. Endocrine complications of bariatric surgery include increased insulin sensitivity with reactive hypoglycemia, non-insulinoma pancreatogenous hypoglycemia syndrome, hypocalcemia, secondary hyperparathyroidism, metabolic bone disease, decreased thyroid hormone requirements in patients with corrected hypothyroidism, correction of gonadal dysfunction that improves fertility and may lead to unintended pregnancy, and vitamin and trace element deficiencies.

Hormones are powerful things, we are helpless in their wake

—Meg Cabot

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Abbreviations

1,25(OH)2D:

1,25Dihydroxy-vitamin D

25(OH)D:

25-Hydroxy-vitamin D

ASBMS:

American Society for Bariatric and Metabolic Surgery

BMI:

Body mass index

BPD-DS:

Biliopancreatic diversion with duodenal switch

EWL:

Excess weight loss

GIP:

Gastric inhibitory polypeptide

GLP-1:

Glucagon-like peptide-1

LAGB:

Laparoscopic adjustable gastric banding

mg:

Milligrams

mg/dL:

Milligrams per deciliter

ng/mL:

Nanograms per milliliter

NIPHS:

Noninsulinoma pancreatogenous hypoglycemia syndrome

PCOS:

Polycystic ovarian syndrome

PTH:

Parathyroid hormone

RYGB:

Roux-en-Y gastric bypass

SAGB:

Single anastomosis gastric bypass

SG:

Sleeve gastrectomy

SHPT:

Secondary hyperparathyroidism

T2DM:

Type 2 diabetes mellitus

TSH:

Thyroid stimulating hormone

VBG:

Vertical banded gastroplasty

VIP:

Vasoactive intestinal peptide

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Authors and Affiliations

  1. Minnesota Center for Obesity, Metabolism and Endocrinology, Eagan, MN, USA

    J. Michael Gonzalez-Campoy, Catherine B. Proebstle, Andrea Pierson, Bronwyn Knaebe & Bruce W. Richardson

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  1. J. Michael Gonzalez-Campoy
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  2. Catherine B. Proebstle
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  3. Andrea Pierson
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  4. Bronwyn Knaebe
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  5. Bruce W. Richardson
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Corresponding author

Correspondence to J. Michael Gonzalez-Campoy .

Editor information

Editors and Affiliations

  1. Bariatric and Laparoscopic Surgery, Global Hospital, Mumbai, India

    Aparna Govil Bhasker

  2. Bhatia Hospital, Mumbai, India

    Nimisha Kantharia

  3. Belle Vue Clinic, Kolkata, India

    Sarfaraz Baig

  4. Belle Vue Clinic, Kolkata, India

    Pallawi Priya

  5. Dr. Aparna’s - Laparoscopy & Bariatric Surgery Centre, Currae Specialty Hospital, Mumbai, India

    Mariam Lakdawala

  6. Dr. Aparna’s - Laparoscopy & Bariatric Surgery Centre, Sterling hospital, Mumbai, Maharashtra, India

    Miloni Shah Sancheti

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Gonzalez-Campoy, J.M., Proebstle, C.B., Pierson, A., Knaebe, B., Richardson, B.W. (2021). Endocrine and Metabolic Complications After Bariatric Surgery. In: Bhasker, A.G., Kantharia, N., Baig, S., Priya, P., Lakdawala, M., Sancheti, M.S. (eds) Management of Nutritional and Metabolic Complications of Bariatric Surgery. Springer, Singapore. https://doi.org/10.1007/978-981-33-4702-1_11

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