# Challenges of Cushing's syndrome and bariatric surgery: a case report with literature review

## TL;DR

A case report highlights the difficulty of diagnosing Cushing's disease in obese patients after bariatric surgery, emphasizing the need for better screening.

## Contribution

The paper presents a rare case of Cushing's disease misdiagnosed after bariatric surgery and reviews literature to highlight diagnostic challenges.

## Key findings

- 65% of Cushing's disease cases reviewed were initially misdiagnosed.
- MRI and immunohistochemistry confirmed pituitary tumors in most cases.
- 55% of patients achieved remission after surgical treatment.

## Abstract

Cushing’s disease (CD), caused by an adrenocorticotropic hormone-secreting pituitary adenoma, is challenging to diagnose, especially in obese patients post-bariatric surgery. This report discusses a misdiagnosed case of CD in a 42-year-old obese male with hypertension. CD was suspected only after surgery, confirmed by magnetic resonance imaging (MRI) showing a pituitary macroadenoma. Despite transsphenoidal surgery and ketoconazole therapy, the patient suffered liver failure and died. Among 20 CD reviewed cases in the literature, 65% were misdiagnosed. MRI and immunohistochemistry confirmed tumors, with 55% achieving remission post-surgery. Screening for CD before bariatric surgery may prevent mismanagement and complications.