ESPE Abstracts (2014) 82 P-D-2-1-520

Pituitary

Hypothalamic Obesity in Children with Craniopharyngioma: Prevalence and Risk Factors of Obesity and Longitudinal Trends of BMI

Ja Hyang Cho, Ja Hye Kim, Yoo-Mi Kim, Jin-Ho Choi & Han-Wook Yoo

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Department of Pediatrics, Asan Medical Center Children’s Hospital, University of Ulsan College of Medicine, Seoul, Republic of Korea


Background: Craniopharyngioma is the most common parasellar tumor in childhood arising from remnants of Rathke’s pouch. As the hypothalamus plays a vital role in regulation of body weight by balancing energy intake and expenditure, hypothalamic damage by structural lesions is one of the most common causes of hypothalamic obesity. This study investigated prevalence, risk factors for the development of hypothalamic obesity, and consequent morbidities in children following treatment of craniopharyngioma.

Methods: Thirty-two patients treated for craniopharyngioma were included. Mean age at diagnosis was 9.6±4.3 years (range, 1–18 years). Mean follow-up duration after surgery was 14.2±4.1 years. Following clinical parameters were analyzed: treatment modalities, tumor locations, presence of pituitary hormone deficiency, and morbidities such as dyslipidemia, non-alcoholic fatty liver disease (NAFLD), and type 2 diabetes.

Results: Twenty-six patients (81.3%) underwent gross total resection and the remaining six patients received subtotal resection. At diagnosis, four patients (12.5%) were overweight and three patients had hypothalamic lesions. At last follow-up (age range, 17.5–36 years; mean, 23.9±4.6 years), 18 patients (54.5%) were obese, six patients (18.2%) were overweight, and eight patients (24.2%) had normal BMI. There was significant increase in BMI at last follow-up (P<0.001). Patients with hypothalamic involvement (n=19) presented higher BMI than those without hypothalamic lesions at diagnosis and last follow-up, but it was not statistically significant. Dyslipidemia was detected in 62.5%, type 2 diabetes in 6.3%, and NAFLD in 12.5%. Unusually, one patient received liver transplantation due to hepatopulmonary syndrome caused by NAFLD.

Conclusion: Most patients underwent gross total resection or adjuvant treatment after subtotal resection, resulting in high prevalence of subsequent obesity, panhypopituitarism, and co-morbidities related to obesity. Obesity and consequent morbidities are more prevalent in patients who underwent gross total resection.

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