[Experience of successful laparoscopic sleeve resection of the stomach and treatment of morbid obesity in a patient with a classic form of congenital adrenal dysfunction].

Q4 Medicine

Problemy endokrinologii Pub Date : 2023-04-30 DOI:10.14341/probl13206

E A Zatsepina, V S Samoilov, A P Volynkina, A V Stepanenko, E E Novichikhina

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Abstract

The article presents a clinical observation of a patient with congenital adrenal dysfunction (CHD), a salt-losing form of 21-hydroxylase enzyme deficiency (homozygous mutation I 172N), and also with morbid obesity, due to long-term use of high doses of glucocorticosteroids, who underwent bariatric surgery - laparoscopic sleeve resection of the stomach. A feature of the presented case is the elimination of one of the causes of decompensation of the disease, namely, overweight, as well as insulin resistance, which requires the intake of large doses of glucocorticoids, which in turn leads to a worsening of the course of obesity, thereby causing a vicious circle. 7 months after surgical treatment, the goal was achieved - a reduction in the dose of Prednisolone by 25%, with a decrease in body weight by 72.1% of overweight.The presented case clearly demonstrates the possibility of performing bariatric surgery for the treatment of morbid obesity in patients with CAH with the participation and control of a specialized multidisciplinary team. If there are indications for bariatric intervention, VDKN should not be an absolute contraindication to such operations, and the ratio of the safety profile and the efficacy profile testifies in favor of the need for their implementation.

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[典型先天性肾上腺功能障碍1例成功的腹腔镜胃套筒切除术及治疗病态肥胖的经验]。

本文报道了一例先天性肾上腺功能障碍(CHD)患者的临床观察，CHD是一种21-羟化酶缺乏症(纯合突变I 172N)的失盐形式，并且由于长期使用高剂量糖皮质激素而伴有病态肥胖，该患者接受了减肥手术-腹腔镜袖式胃切除术。本病例的一个特点是消除了该疾病代偿失调的原因之一，即超重，以及胰岛素抵抗，这需要摄入大剂量的糖皮质激素，这反过来又导致肥胖过程的恶化，从而造成恶性循环。手术治疗7个月后，目标实现了——强的松龙的剂量减少了25%，超重的体重减少了72.1%。本病例清楚地表明，在一个专业的多学科团队的参与和控制下，对CAH患者的病态肥胖进行减肥手术治疗的可能性。如果有减肥干预的适应症，VDKN不应该是这类手术的绝对禁忌症，安全性和有效性的比值证明了它们的实施是必要的。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Problemy endokrinologii Medicine-Endocrinology, Diabetes and Metabolism

CiteScore

1.40

自引率

0.00%

发文量

期刊介绍： Since 1955 the “Problems of Endocrinology” (or “Problemy Endocrinologii”) Journal publishes timely articles, balancing both clinical and experimental research, case reports, reviews and lectures on pressing problems of endocrinology. The Journal is aimed to the most topical issues of endocrinology: to chemical structure, biosynthesis and metabolism of hormones, the mechanism of their action at cellular and molecular level; pathogenesis and to clinic of the endocrine diseases, new methods of their diagnostics and treatment. The Journal: features original national and foreign research articles, reflecting world endocrinology development; issues thematic editions on specific areas; publishes chronicle of major international congress sessions and workshops on endocrinology, as well as state-of-the-art guidelines; is intended for scientists, endocrinologists diabetologists and specialists of allied trade, general practitioners, family physicians and pediatrics.