Adrenal insufficiency unmasked following laparoscopic sleeve gastrectomy: A rare case report

Laparoscopic sleeve gastrectomy (LSG) is a common bariatric surgery with proven metabolic benefits. However, it can trigger endocrine disturbances, including adrenal insufficiency (AI). AI is rare but potentially life-threatening, and its symptoms often mimic normal postoperative recovery, leading to delayed diagnosis. This overlap may obscure early recognition in post-LSG patients.

A report a 49-year-old woman who developed fatigue, anorexia, orthostatic hypotension, and hyponatremia four weeks post-LSG. Initial symptoms were attributed to expected recovery. Persisting signs prompted hormonal testing, which revealed low cortisol and an inadequate response to cosyntropin stimulation, confirming secondary AI. Hydrocortisone therapy was initiated, resulting in rapid symptom resolution and biochemical normalization.

Postoperative physiological stress and rapid weight loss may disrupt hypothalamic-pituitary-adrenal function. Secondary AI lacks hallmark signs, making diagnosis particularly challenging after LSG. This case emphasizes the need to consider AI in patients with disproportionate fatigue and electrolyte imbalance. Timely diagnosis and treatment are crucial to prevent adrenal crisis.

AI is a rare but serious postoperative complication of LSG. Its recognition is hindered by nonspecific symptoms and diagnostic overlap with normal recovery. Endocrine evaluation should be considered in atypical or prolonged postoperative courses. Early intervention improves outcomes and may prevent life-threatening complications.