Hypothalamic Obesity (HyOb) is the most flagitious endocrinologic problem following surgical intervention for childhood brain tumors. There is still no curative therapy for HyOb.
A 4y 10/12 m old girl presented with headache and vomiting. Pituitary MRI revealed a craniopharyngioma and she was operated. The replacement therapies for postop panhypopituitarism was given but she developed HyOb within 4 months after operation (table-1). Somatostatin analogue (SA) (octreotide, 10 mcg/kg/d) was initiated at 6.months of postop period due to hyperinsulinism in OGTT and also GH treatment was added (table-2). Although, she was diabetic and still hyperinsulinemic in 1 year later OGTT, octreotide demonstrated significant reduction in BMI SDS (table-1, 2). Since she had normal HbA1c and normoglycemia in blinded CGM except one value, octreotide octreotide-LAR was switched (7.5 mcg/kg/d). As a side effect, a gall calculi was developed 4 months later, ursodeoxycholic acid was added. But the octreotide-LAR was stopped at 6.months due to suspicion of acute cholecystitis. After 3 months, she had kept same weight with BMI SDS reduction (table-1).
SA might be still an option in some selected patients with HyOb. Although the reason of using SA in HyOb is hyperinsulinism, this case showed that hyperinsulinism still continue under successful SA therapy with delayed insulin peak.
|GHST||First OGTT||Second OGTT (30.min later octreotide injection)|
|GH (ng/ml)||Glucose (mg/dl)||Insulin (mcU/ml)||Glucose (mg/dl)||Insulin (mcU/ml)|
19 - 21 Sep 2019
European Society for Paediatric Endocrinology