Background: Obesity is a well-recognized complication of craniopharyngioma. Increased hypothalamic involvement (HI) by the tumour and accordant treatment has been associated with greater obesity. Changes in hypothalamic control of the autonomic nervous system (ANS) have been implicated in the development of hypothalamic obesity however, long term changes in the ANS have not been assessed.
Objective and hypotheses: We aimed to evaluate ANS activity using heart rate variability (HRV) in children and young adults with long term follow up for craniopharyngioma. Associations between HRV, degree of HI, obesity, physical activity and metabolic abnormalities were analysed.
Method: HRV was assessed in 28 children and young adults (14 males) aged 1030 years with more than 3 years of follow up after initial surgery. Anthropometrics, fasting metabolic sample, physical activity measures by questionnaire was obtained at the time of HRV testing. A retrospective review of the pre and postoperative clinical course and grading of HI on magnetic resonance imaging (MRI) was done.
Results: The mean postoperative follow up was 11.6 (range 3.621.1) years. Patients with greater HI showed increased BMI z-score at the time of study. S.D. of the NN interval (SDNN) and total power (TP), indices of the overall variability, were decreased with greater HI. High frequency (HF), a parameter of parasympathetic activity, was decreased (195±183 m2 vs 409±326 m2) while the low frequency (LF) to HF ratio, a parameter of sympathetic activity was increased (1.76±1.73 vs 0.80±0.49). HF negatively correlated with fasting glucose (P=0.041) and triglyceride (P<0.001) and positively correlated with physical activity (P=0.047).
Conclusion: Greater HI in craniopharyngioma showed decreased overall HRV with increased sympathetic and decreased parasympathetic activity. Decreased parasympathetic activity was associated with metabolic abnormalities in glucose and triglyceride levels. These results provide a new perspective regarding autonomic dysfunction in long term follow up of craniopharyngioma.
01 Oct 2015 - 03 Oct 2015