All That Glitters Is Not Gold – The Patient With 'Excellent' Weight Loss Following Bariatric Surgery

A 33-year-old man with a history of obesity underwent laparoscopic sleeve gastrectomy in March 2021, resulting in a weight loss of 37.6%. However, he was referred for evaluation of persistent fatigue in March 2023. Investigations revealed anemia, deficiencies of iron, folate, zinc, and vitamin D, and hypocortisolism. The patient was given oral hydrocortisone and restarted on multivitamins, iron, folate, zinc, and vitamin D supplements, which resolved his fatigue. This is the first reported case of a patient developing hypocortisolism following isolated sleeve gastrectomy. The underlying mechanisms remain unclear. The case highlights the need for clinicians to consider hypocortisolism in patients with nonspecific symptoms post bariatric surgery, including unanticipated weight loss.