Background: Hypothalamic obesity (HO), due to midline congenital malformations, genetic diseases or hypothalamo-hypophysis tumours, is severe and difficult to treat. Patients are scarcely compliant to diet and physical activity, for disabilities often affecting them. Drugs have been rarely employed.
Objective and hypotheses: Aim of the study was to treat hypopituitaric children and adolescents affected by severe HO with a multidisciplinary approach including endocrine, dietary, physical exercise, psychological measures and, in case of failure, pharmacological and surgical treatment.
Method: Fourteen hypopituitary (five congenital and nine acquired) subjects (six males and eight females), age range from 8 to 16 years, have been enrolled between July 2013 and February 2014. At 036 months, height, weight, BMI, serum glucose, insulin, triglycerides, cholesterol, and HOMA-index have been evaluated. At time 0 they received: personalized diet, USB digital support monitoring daily physical exercise, psychological evaluation. Therapeutic efficacy was defined after 6 months: good in case of BMI improvement; inefficacy in case of BMI worsening and/or HOMA index >4. In the four not responsive adolescents, we employed metphormine (500 mg twice/daily) for 3 months, when they were re-evaluated and shifted to GLP-analogue if still not responsive.
Results: Time 0: 14/14 BMI >90° (of whom 11>97°), HOMA >4 in 3/14 patients. At 3 months: 2/10 BMI stability or reduction and/or HOMA improvement. At 6 months: 0/5 BMI stability or reduction and/or HOMA improvement, 4/5 started metphormine treatment. After 3 months of metphormine treatment 2/4 showed BMI stability or reduction and/or HOMA improvement. Patients that are not responsive are starting GLP-analogue. The follow-up of the other patients is ongoing.
Conclusion: Multidisciplinary approach to HO including physical exercise, diet, psychological support and drugs can give partial favourable results in these challenging condition. This kind of treatment should be started as soon as possible to prevent severe deterioration of BMI and metabolism.
20 - 22 Sep 2014
European Society for Paediatric Endocrinology