A case of severe anorexia, excessive weight loss and high peptide YY levels after sleeve gastrectomy

Sleeve gastrectomy (SG) is the second most commonly performed bariatric procedure worldwide. Altered circulating gut hormones have been suggested to contribute post-operatively to appetite suppression, decreased caloric intake and weight reduction. In the present study, we report a 22-year-old woman...

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Main Authors:	Pucci, Andrea, Cheung, Wui Hang, Jones, Jenny, Manning, Sean, Kingett, Helen, Adamo, Marco, Elkalaawy, Mohamed, Jenkinson, Andrew, Finer, Nicholas, Doyle, Jacqueline, Hashemi, Majid, Batterham, Rachel L
Format:	Online
Language:	English
Published:	Bioscientifica Ltd 2015
Online Access:	https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4674657/

id	pubmed-4674657
recordtype	oai_dc
spelling	pubmed-46746572015-12-10 A case of severe anorexia, excessive weight loss and high peptide YY levels after sleeve gastrectomy Pucci, Andrea Cheung, Wui Hang Jones, Jenny Manning, Sean Kingett, Helen Adamo, Marco Elkalaawy, Mohamed Jenkinson, Andrew Finer, Nicholas Doyle, Jacqueline Hashemi, Majid Batterham, Rachel L Endocrinology and Psychology Sleeve gastrectomy (SG) is the second most commonly performed bariatric procedure worldwide. Altered circulating gut hormones have been suggested to contribute post-operatively to appetite suppression, decreased caloric intake and weight reduction. In the present study, we report a 22-year-old woman who underwent laparoscopic SG for obesity (BMI 46 kg/m2). Post-operatively, she reported marked appetite reduction, which resulted in excessive weight loss (1-year post-SG: BMI 22 kg/m2, weight loss 52%, >99th centile of 1-year percentage of weight loss from 453 SG patients). Gastrointestinal (GI) imaging, GI physiology/motility studies and endoscopy revealed no anatomical cause for her symptoms, and psychological assessments excluded an eating disorder. Despite nutritional supplements and anti-emetics, her weight loss continued (BMI 19 kg/m2), and she required nasogastric feeding. A random gut hormone assessment revealed high plasma peptide YY (PYY) levels. She underwent a 3 h meal study following an overnight fast to assess her subjective appetite and circulating gut hormone levels. Her fasted nausea scores were high, with low hunger, and these worsened with nutrient ingestion. Compared to ten other post-SG female patients, her fasted circulating PYY and nutrient-stimulated PYY and active glucagon-like peptide 1 (GLP1) levels were markedly elevated. Octreotide treatment was associated with suppressed circulating PYY and GLP1 levels, increased appetite, increased caloric intake and weight gain (BMI 22 kg/m2 after 6 months). The present case highlights the value of measuring gut hormones in patients following bariatric surgery who present with anorexia and excessive weight loss and suggests that octreotide treatment can produce symptomatic relief and weight regain in this setting. Bioscientifica Ltd 2015-06-01 2015 /pmc/articles/PMC4674657/ /pubmed/26664728 http://dx.doi.org/10.1530/EDM-15-0020 Text en © 2015 The authors This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivs 3.0 Unported License (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.en_GB) .
repository_type	Open Access Journal
institution_category	Foreign Institution
institution	US National Center for Biotechnology Information
building	NCBI PubMed
collection	Online Access
language	English
format	Online
author	Pucci, Andrea Cheung, Wui Hang Jones, Jenny Manning, Sean Kingett, Helen Adamo, Marco Elkalaawy, Mohamed Jenkinson, Andrew Finer, Nicholas Doyle, Jacqueline Hashemi, Majid Batterham, Rachel L
spellingShingle	Pucci, Andrea Cheung, Wui Hang Jones, Jenny Manning, Sean Kingett, Helen Adamo, Marco Elkalaawy, Mohamed Jenkinson, Andrew Finer, Nicholas Doyle, Jacqueline Hashemi, Majid Batterham, Rachel L A case of severe anorexia, excessive weight loss and high peptide YY levels after sleeve gastrectomy
author_facet	Pucci, Andrea Cheung, Wui Hang Jones, Jenny Manning, Sean Kingett, Helen Adamo, Marco Elkalaawy, Mohamed Jenkinson, Andrew Finer, Nicholas Doyle, Jacqueline Hashemi, Majid Batterham, Rachel L
author_sort	Pucci, Andrea
title	A case of severe anorexia, excessive weight loss and high peptide YY levels after sleeve gastrectomy
title_short	A case of severe anorexia, excessive weight loss and high peptide YY levels after sleeve gastrectomy
title_full	A case of severe anorexia, excessive weight loss and high peptide YY levels after sleeve gastrectomy
title_fullStr	A case of severe anorexia, excessive weight loss and high peptide YY levels after sleeve gastrectomy
title_full_unstemmed	A case of severe anorexia, excessive weight loss and high peptide YY levels after sleeve gastrectomy
title_sort	case of severe anorexia, excessive weight loss and high peptide yy levels after sleeve gastrectomy
description	Sleeve gastrectomy (SG) is the second most commonly performed bariatric procedure worldwide. Altered circulating gut hormones have been suggested to contribute post-operatively to appetite suppression, decreased caloric intake and weight reduction. In the present study, we report a 22-year-old woman who underwent laparoscopic SG for obesity (BMI 46 kg/m2). Post-operatively, she reported marked appetite reduction, which resulted in excessive weight loss (1-year post-SG: BMI 22 kg/m2, weight loss 52%, >99th centile of 1-year percentage of weight loss from 453 SG patients). Gastrointestinal (GI) imaging, GI physiology/motility studies and endoscopy revealed no anatomical cause for her symptoms, and psychological assessments excluded an eating disorder. Despite nutritional supplements and anti-emetics, her weight loss continued (BMI 19 kg/m2), and she required nasogastric feeding. A random gut hormone assessment revealed high plasma peptide YY (PYY) levels. She underwent a 3 h meal study following an overnight fast to assess her subjective appetite and circulating gut hormone levels. Her fasted nausea scores were high, with low hunger, and these worsened with nutrient ingestion. Compared to ten other post-SG female patients, her fasted circulating PYY and nutrient-stimulated PYY and active glucagon-like peptide 1 (GLP1) levels were markedly elevated. Octreotide treatment was associated with suppressed circulating PYY and GLP1 levels, increased appetite, increased caloric intake and weight gain (BMI 22 kg/m2 after 6 months). The present case highlights the value of measuring gut hormones in patients following bariatric surgery who present with anorexia and excessive weight loss and suggests that octreotide treatment can produce symptomatic relief and weight regain in this setting.
publisher	Bioscientifica Ltd
publishDate	2015
url	https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4674657/
_version_	1613511462109577216

A case of severe anorexia, excessive weight loss and high peptide YY levels after sleeve gastrectomy

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