Cushing Syndrome Secondary to Adrenal Adenoma Diagnosed Following Unsuccessful Bariatric Surgery: A Case Report

Cushing syndrome (CS) is a rare endocrine disorder often overlooked in obese patients. Diagnosis of CS post bariatric surgery represents an emerging clinical concern with potentially severe consequences. A 26‐year‐old Saudi female presented with inadequate weight loss following sleeve gastrectomy. Despite an initial body mass index (BMI) of 44 kg/m 2 (101.7 kg), she achieved minimal weight loss (15 kg) over 1 year with persistent hypertension and diabetes. Physical examination revealed classic cushingoid features, including plethoric rounded face, dorsocervical fat pad, wide purple striae, and easy bruising. Laboratory investigations confirmed hypercortisolism with elevated 24‐h urinary free cortisol (1,034 nmol/day, reference range 100–379 nmol/day), failed dexamethasone suppression, and suppressed adrenocorticotropic hormone (ACTH) (0.2 pmol/L, reference range 1.6–13.9 pmol/L), indicating ACTH‐independent CS. Imaging revealed bilateral adrenal nodular enlargement with a prominent right‐sided adenoma (2.3 × 2.3 × 2.8 cm). Following right adrenalectomy, the patient experienced dramatic improvement with a 10.7% weight reduction of 10.5 kg (98.3–87.8 kg; BMI 42.5–38), blood pressure normalization, and excellent glycemic control (Hemoglobin A1c [HbA1c] 9.8%–6.4%). This case highlights the need to consider CS both before bariatric surgery, particularly in patients with multiple features of hypercortisolism, and in patients with poor outcomes post bariatric surgery. Though rare, it is a reversible and treatable cause of obesity that should not be missed when clinical features are suggestive.