Introduction: Glucagon-like peptide 1 (GLP-1) receptor agonists have been successfully used in adults with hypothalamic obesity, showing a BMI decrease and metabolic profile improvement. Data on GLP-1 receptor agonist treatment for children and adolescents is limited. Herein, we present a clinical case of a male adolescent treated with GLP-1 receptor agonist for hypothalamic obesity, secondary to craniopharyngioma.
Case report: A 15.8 year-old boy (Height-SDS: −2.59; BMI-SDS: +0.82), who had undergone a clift-lip operation in the 1st year of life, was seen for short stature with diminished growth speed and pubertal delay. His medical history was otherwise uneventful. A cerebral MRI revealed a cystic and solid supra-sellar tumor, extending to the hypothalamus and compressing the optic chiasma, as well as intratumoral calcification. Tumor histology revealed adamantinomatous craniopharyngioma, OMS grade 1. Gamma knife radiotherapy was performed 9 months after the initial operation due to a residual tumor.
Results: After tumor resection, the patient presented hemianopsia and panhypopituitarism, requiring L-thyroxine, vasopressine and hydrocortisone substitution therapy. He showed a rapid onset obesity suggesting hypothalmic damage. Exponential weight gain persisted despite rigorous hygieno-dietetic measures, with BMI-SDS rising from +0.82 to +4.99 in 11 months. Exenatide 5mcg 2x/day was introduced, which allowed BMI stabilization. The treatment was well tolerated without hypoglycemic events as controlled by flash glucose monitoring (FreestyleLibre®). He reported a better quality of life and regained satiation. Testosterone and growth hormone substitution were introduced 17 months after tumor resection, with further improvement of quality of life.
Discussion: GLP-1 receptor agonist treatment appears to be promising in adolescents with hypothalamic obesity. Further studies with larger cohorts are required in order to evaluate its longtime effectiveness for BMI and metabolic control.
27 Sep 2018 - 29 Sep 2018