Background: Craniopharyngioma is the most common parasellar tumor in childhood arising from remnants of Rathkes 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, 118 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, 17.536 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.
20 - 22 Sep 2014
European Society for Paediatric Endocrinology