ESPE2023 Free Communications Fat, metabolism and obesity 2 (6 abstracts)
Impact of growth hormone therapy on body mass index in childhood-onset craniopharyngioma: a multicenter Italian study in 117 patients.
Benedetta Ciacchini 1 , Stefano Zucchini 2 , Gabriella Pozzobon 3 , Stefania Pedicelli 4 , Maria Parpagnoli 5 , Daniela Driul 6 , Patrizia Matarazzo 7 , Federico Baronio 8 , Marta Panciroli 9 , Cristina Partenope 3 , Beatrice Nardini 5 , Graziamaria Ubertini 4 , Rachele Menardi 10 , Chiara Guzzetti 11 , Lorenzo Iughetti 12 , Tommaso Aversa 13 , Raffaella Di Mase 14 , Alessandra Cassio 2 & Natascia Di Iorgi 15,16
1Division of Paediatrics, Department of Health Sciences, University of Piemonte Orientale, 28100 Novara, Italy. 2Pediatric Endocrine Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Endo-ERN Center for Rare Endocrine Conditions, 40138 Bologna, Italy. 3Department of Paediatrics, IRCCS San Raffaele Scientific Institute, Vita Salute San Raffaele University, Endo-ERN Center for Rare Endocrine Conditions, 20132 Milan, Italy. 4Dipartimento Pediatrico Universitario Ospedaliero, IRCCS “Bambino Gesù” Children’s Hospital, 00165 Rome, Italy. 5Auxo-Endocrinology and Gynecology Meyer Children’s University Hospital, 50139 Florence, Italy. 6Division of Pediatrics, University Hospital Santa Maria della Misericordia, ASUFC, 33100 Udine, Italy. 7Department of Pediatric Endocrinology, Regina Margherita Children’s Hospital, University of Turin, 10126 Turin, Italy. 8Baronio Pediatric Endocrine Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Endo-ERN Center for Rare Endocrine Conditions, 40138 Bologna, Italy. 9Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, 16132 Genova, Italy. 10Division of Paediatrics, Department of Medicine (DAME) University of Udine, 33100 Udine, Italy. 11Pediatric Endocrine Unit, Pediatric Hospital Microcitemico Antonio Cao, AO Brotzu, 09121 Cagliari, Italy. 12Pediatric Unit, Department of Medical and Surgical Sciences for Mothers, Children and Adults, University of Modena and Reggio Emilia, 41124 Modena, Italy. 13Unit of Paediatrics, Department of Human Pathology of Adulthood and Childhood, University of Messina, 98124 Messina, Italy. 14University Federico II, Department of Translational Medical Sciences, 80131 Naples, Italy. 15Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genova, 16147 Genoa, Italy. 16Department of Pediatrics, IRCCS Istituto Giannina Gaslini, 16147 Genoa, Italy
Background: patients with childhood-onset craniopharyngioma (CO-CP) present long-term outcomes, including growth hormone (GH) deficiency and obesity. Currently, data on the effects of GH therapy (GHT) on the body mass index (BMI) in CP are inconclusive. Aims of the study were to evaluate BMI over time and its determinants in a large cohort of CO-CP patients treated with GH therapy (GHT).
Methods: a multicenter retrospective study conducted by the Italian growth working group of the Italian Society of Pediatric Endocrinology involved 117 CO-CP subjects treated with GHT, followed between 2000 and 2018. Seventy-five underwent transcranial-TC, and 34 transsphenoidal-TNS surgery. Height SDS, BMI SDS, Tanner stage, GHT start (GHS) date, GH dose were collected at the time of CF diagnosis (n=78), 4-6 months after surgery (n=95), GHS (n=112), pubertal induction/start (n=78) and final height (FH, n=46). Forty-six patients presented a CF relapse.
Results: GHT improved height (P<0.0001) from GHS to FH, while BMI SDS only slightly decreased (P=0.23). Overall, BMI steeply increased after surgery (from 0.8±1.7 to 1.7±1.6SDS; +0.8SDS, P<0.0001) and decreased from GHS up to puberty (-0,36SDS, P<0.0001). No gender differences were observed. The TC group displayed a higher BMI SDS than the TNS surgery group already at CF diagnosis, after surgery and at GHS (all P<0.01); at FH a borderline difference persisted (P=0.08). Age at GHS was 10.7±4.1 yrs, at puberty 13.3±1.6 yrs. GHT was initiated at a mean dose of 4.9±2.3 mcg/m2/week; within 6 mts after surgery in 15 (12.8%), 12 mts in 26 (22.2%), 24 mts in 36 (30.8%) and >24 mts in 40 (34.2%). The latter group showed higher BMI SDS than patients that started earlier (P<0.01); BMI differences persisted up to FH. BMI SDS at FH was predicted by BMI SDS at GHS (coeff 0.93, P<0,0001) and negatively by GHT duration (coeff 0.132, P=0.03), but not by GHT dose (R2 0.611). Twenty-six patients (58,7%) relapsed before and 19 (41,3%) after GHS (P=0.49).
Conclusion: we demonstrated in our large cohort of CO-CP that GHT improved height and slightly BMI SDS at the time of puberty but not at FH; however, most patients started GHT later than 6 mts after surgery. TNS surgery, a longer GHT duration and a lower BMI at GH start seem associated to a lower BMI over time. The actual dose does not increase the risk of CP recurrence; studies are needed to evaluate the impact of different GH doses on BMI.
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