ESPE Abstracts

Although craniopharyngiomas are low-grade tumours, long-term survivors frequently suffer from severe morbidity due to hypothalamic lesions, such as hypothalamic obesity, that is largely resistant to lifestyle modification and pharmacotherapy. We investigated the efficacy of bariatric surgery in two patients with craniopharyngioma-related hypothalamic obesity during 18 months of follow-up. Patient n1, diagnosed with craniopharyngioma and treated with complete surgical excision at 11 years of age. Subsequently, she developed panhypopituitarism, hypothalamic obesity (BMI>40 kg/m2 at 15 years of age), diabetes mellitus (HbA1c 48 mmol/mol, fasting blood sugar 102 mg/dl), dyslipidaemia (triglycerides 296 mg/dl), NAFLD with hepatic steatosis and elevated transaminases. Dietary intervention and exercise were ineffective as she kept gaining weight; hence, she was started on Metformin and Semaglutide, without success. At the age of 21 her bodyweight was 180 kg (BMI 54 kg/m2); therefore, according to the European guidelines (severe obesity associated with comorbidities), she was candidate for bariatric surgery and underwent sleeve gastrectomy. Within 6 months after the surgery, she achieved a weight loss of 40 kg, 22% of her initial weight. During the follow-up the blood tests showed complete remission of diabetes mellitus (HbA1c 33 mmol/mol, fasting glycaemia 77 mg/dl) allowing discontinuation of the antidiabetic therapy; the laboratory testing also revealed normal lipidic profile and liver function. No complications were observed. Patient n2, surgically treated for craniopharyngioma with complete removal at the age of 12. Afterward he developed panhypopituitarism, severe hypothalamic obesity (BMI>40 kg/m2 at 15 years of age), insulin-resistance (HOMA-IR 4.6), dyslipidaemia (HDL 28 mg/dl, triglycerides 194 mg/dl), OSA. Lifestyle modification was inadequate for weight loss; hence, after multidisciplinary evaluation, sleeve gastrectomy was applied at the age of 19 (BMI 56 kg/m2, weight 190 kg). After bariatric surgery he lost weight markedly and continuously, with a substantial weight loss of 33% of bodyweight (64 kg). The BMI has reduced by 18 units. Moreover, levels of glycated haemoglobin and insulin declined during the first month (HOMA-IR 2.4); hypoglycaemic therapy was discontinued. An improvement of lipid profile was achieved (HDL 57 mg/dl, triglycerides 98 mg/dl). These results were consistent during 18 months of follow-up. No major complications occurred. This double case-report revealed that dietary interventions and pharmacotherapy could be unsuccessful in patients with craniopharyngioma-related hypothalamic obesity. Bariatric surgery could be a promising therapeutic option to promote weight loss and improve or even resolve comorbid conditions such as diabetes mellitus and dyslipidaemia.