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A 47-year-old man with discomfort in the upper chest, difficulty swallowing food and drinks, and weight loss of 10 kg over 2 months underwent computed tomography (CT), which excluded malignancy but showed an enlarged thymus. He reported bulging of his eye, increased bowel movements, heat intolerance, and palpitations, and he had a family history of Graves disease. Examination of the thyroid gland was normal, and he had exophthalmos affecting the right eye. Laboratory tests showed a thyrotropin level of less than 0.01 (normal 0.35 to 5.50) mIU/L, free thyroxine 34.1 (normal 10.0 to 20.0) pmol/L, and thyrotropin receptor antibody 4.4. He was diagnosed with Graves disease associated thymic hyperplasia and prescribed antithyroid medication. Thyroid function quickly returned to normal and stabilized with carbimazole monotherapy. Follow-up CT 5.5 months later showed regression of the thymus to a normal size.

Bariatric surgery is most commonly carried out in women of childbearing age. Whilst fertility rates are improved, pregnancy following bariatric surgery poses several challenges. Whilst rates of many adverse maternal and foetal outcomes in obese women are reduced after bariatric surgery, pregnancy is best avoided for 12–24 months to reduce the potential risk of intrauterine growth retardation. Dumping syndromes are common after bariatric surgery and can present diagnostic and therapeutic challenges in pregnancy. Early dumping occurs due to osmotic fluid shifts resulting from rapid gastrointestinal food transit, whilst late dumping is characterized by a hyperinsulinemic response to rapid absorption of simple carbohydrates. Dietary measures are the mainstay of management of dumping syndromes but pharmacotherapy may sometimes become necessary. Acarbose is the least hazardous pharmacological option for the management of postprandial hypoglycemia in pregnancy. Nutrient deficiencies may vary depending on the type of surgery; it is important to optimize the nutritional status of women prior to and during pregnancy. Dietary management should include adequate protein and calorie intake and supplementation of vitamins and micronutrients. A high clinical index of suspicion is required for early diagnosis of surgical complications of prior weight loss procedures during pregnancy, including small bowel obstruction, internal hernias, gastric band erosion or migration and cholelithiasis.

A 33-year-old woman was presented to their outpatient endocrinology clinic with worsening hypertension (clinic blood pressure reading 169/112 mm Hg) despite treatment with perindopril 4 mg daily. She reported a history of easy bruising without other symptoms of endocrine hormone excess, such as palpitation, anxiety, flushing, sweating, and headache. She had no history of fragility fractures or diabetes, and no family history of hypertension. The patient had generalized adiposity, with a body mass index (BMI) score of 30.9, but no other overt clinical features of Cushing syndrome such as facial plethora, striae, or proximal myopathy. Several years prior, from the age of 26 years, the patient had undergone investigations for secondary hypertension in a hypertension clinic in Canada. Further investigations and management were not undertaken because she relocated to England. Clinical correspondence supplied to the patient reported that renal magnetic resonance imaging (MRI) excluded renal artery stenosis and fibromuscular dysplasia, but a left-sided adrenal nodule measuring 0.9 × 0.5 cm was discovered, aldosterone-to-renin ratio was normal, 24-hour urinary free cortisol was elevated on 2 occasions, and a 1-mg dexamethasone suppression test was \"positive.\"

The widespread use of bariatric surgery for the treatment of morbid obesity has led to a dramatic increase in the numbers of women who become pregnant post-surgery. This can present new challenges, including a higher risk of protein and calorie malnutrition and micronutrient deficiencies in pregnancy due to increased maternal and fetal demand. We undertook a focused, narrative review of the literature and present pragmatic recommendations. It is advisable to delay pregnancy for at least 12 months following bariatric surgery. Comprehensive pre-conception and antenatal care is essential to achieving the best outcomes. Nutrition in pregnancy following bariatric surgery requires specialist monitoring and management. A multidisciplinary approach to care is desirable with close monitoring for deficiencies at each trimester.

Background Obesity poses significant challenges to healthcare globally, particularly through its bi‐directional relationship with co‐morbid metabolic conditions such as type 2 diabetes and hypertension. There is also emerging evidence of an association between obesity and chronic kidney disease (CKD) which is less well characterized. Methods A literature search of electronic libraries was conducted to identify and present a narrative review of the interplay between obesity and CKD. Findings Obesity may predispose to CKD directly as it is linked to the histopathological finding of obesity‐related glomerulopathy and indirectly through its widely recognized complications such as atherosclerosis, hypertension, and type 2 diabetes. The biochemical and endocrine products of adipose tissue contribute to pathophysiological processes such as inflammation, oxidative stress, endothelial dysfunction, and proteinuria. The prevention and management of obesity may prove critical in counteracting both the development and advancement of CKD. Moreover, measures of abdominal adiposity such as waist circumference, are generally associated with worse morbidity and mortality in individuals receiving maintenance hemodialysis. Conclusion Obesity is a risk factor for the onset and progression of CKD and should be recognized as a potential target for a preventative public health approach to reduce CKD rates within the general population. Future research should focus on the use of glucagon‐like peptide‐1 receptor agonists and sodium–glucose cotransporter 2 inhibitors in patients with CKD and obesity due to their multi‐faceted actions on major outcomes. Visual Obesity poses significant challenges to healthcare globally, particularly through its bi‐directional relationship with co‐morbid metabolic conditions such as type 2 diabetes and hypertension. In addition, it increases the risk of onset and progression of CKD through direct and indirect pathways. Therefore, obesity should be recognized as a potential target for a preventative public health approach to reduce CKD rates within the general population.