Obesity Abstracts

We present the case of a 28-year-old woman who initially presented aged 11 with a brain tumour in 2002. This was diagnosed as a craniopharyngioma and managed with neurosurgery, a ventriculoperitoneal (VP) shunt and radiotherapy. The consequence of this treatment gradually rendered her panhypopituitary and caused hypothalamic injury. Medications which were commenced around this time include hydrocortisone, thyroxine, desmopressin and growth hormone. The hypothalamic insult in turn led to a diagnosis of ‘hypothalamic obesity’, with hyperphagia leading to significant and rapid weight gain. By age 20, she had reached a weight of 117 kg, which led obesity surgery where she had a gastric band placed. This initially led to a significant improvement in weight to 84.2 kg by 2013. However, by 2014, problems with the gastric band began to emerge with symptoms of intermittent vomiting and acid reflux, and, in addition, her calorie intake led to weight regain. Investigations between 2014 to 2015 including barium swallow and gastroscopy firstly revealed a marked restriction through the band and later showed slippage of the gastric band. An MDT decision was thus made in conjunction with the patient to remove the gastric band in 2015. Unfortunately however, this led to further weight gain, and within 6 months of removal of the gastric band, her weight had increased to 115 kg and she underwent a laparoscopic sleeve gastrectomy. Within one year of this procedure however, she had lost no weight. At this point, the patient was not keen on any further surgical therapy so she was trialled on the GLP-1 agonist Liraglutide at a dose of 1.2 mg daily. With this regimen, she had 10 kg weight loss within 4 months. This dose was then uptitrated to 3 mg daily and by 9 months of commencing Liraglutide, she had lost 15% of her body weight, with her weight being 97.7 kg. At this point, she was concerned regarding weight regain and was thus reconsidered for further surgery. In early 2019, she therefore underwent a mini-gastric bypass which has led to further beneficial results with her latest weight being 84.9 kg.