ESPE Abstracts (2014) 82 P-D-3-2-779

Younger Age and BMI [gt]3SD are Risk Factors for Mortality in Children with Hypothalamic Obesity

Belma Haliloglu, Serap Turan, Zeynep Atay, Tulay Guran, Saygın Abalı, Serpil Bas & Abdullah Bereket

Pediatric Endocrinolgy Department, Marmara University School of Medicine, Istanbul, Turkey

Background: Hypothalamic obesity is the most flagitious endocrinologic problem following surgical intervention for childhood brain tumors. Thus, recognition of this condition and identification of risk factors for mortality is important.

Objective and hypotheses: In this study, we have shared our single center experience in obesity-related mortality in children with hypothalamic obesity.

Method: We retrospectively analyzed 20 patients with HyOb in whom we had minimum follow-up of 3 years.

Results: The mean age was 6.36±3.60 (0.50–13.82) years, BMISDS was 0.80±1.25 (−1.74±2.55) at diagnosis. The mean duration of follow-up was 6.02±2.5 years (3.3–11.9 years). The most common histologic diagnoses were optic glioma (45%) and craniopharyngioma (40%). ΔBMISDS 0–6 months (difference between BMI SDS at diagnosis and 6 months after tumor therapy) was very high (1.89 SDS), but this rapid increment in weight did not continue on 6–12 months after treatment (Table 1). ΔBMISDS 0–6 months was significantly higher in patients younger than 6 years at diagnosis compared to those who were older than 6 years at diagnosis (P<0.001) (Table 1). Four cases died during follow-up and mortality rate was 4.5-fold higher in patients younger than 6 years compared to those older than 6 years at the time of diagnosis (37.5 vs 8.3%). Mortality rate was also 3.7-fold higher in patients whose maximum BMISDS ≥3 at anytime during first 3 years after tumor therapy.

Table 1. BMI SDS and ΔBMI SDS values.
Age at diagnosis
All patients (n=15)(≤6 years (n=5)>6 years (n=10)P value
BMI SDS at diagnosis0.77±1.260.10±1.631.14±0.910.074
BMI SDS 6 months2.66±1.453.82±1.862.02±0.630.01
BMI SDS 12 months2.73±1.353.78±1.592.09±0.61<0.01
ΔBMI SDS 0–6 months1.79±1.853.71±1.960.83±0.73<0.001
ΔBMI SDS 6–12 months0.04±0.42−0.04±0.500.07±0.380.36

Conclusion: This study underlined the importance of first 6 months after tumor therapy in regards to weight gain. It also identifies for the first time that children who were diagnosed younger than 6 years old and max BMISDS ≥3 at anytime during first three years after therapy are at risk for increased mortality.

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