ESPE Abstracts

Background: Severe hypothalamic obesity (HO) is frequent sequelae in craniopharyngioma (CP) patients after surgery with or without radiotherapy. The pathophysiological mechanisms behind HO include impairment of the hypothalamic structures controlling satiety and energy expenditure. Weight gain often continues despite adequate pituitary hormone substitution, and conventional lifestyle changes as exercise and reduced caloric intake rarely have a lasting weight reducing effect in these patients. The glucagon like-peptide-1 receptor agonist (GLP1 RA) semaglutide, working through receptors in the gastrointestinal channel as well as in the central nervous system including the hypothalamus, has shown convincing efficacy in obesity treatment. However, the effect of semaglutide in treating CP related HO is sparsely studied.

Objective: To present the weight reducing effect of the GLP1 RA semaglutide in three adolescents with severe HO after surgery with or without radiotherapy for a craniopharyngioma.

Case reports: Patient 1: A boy diagnosed with CP ten years old. The tumor was surgically removed. Due to relapse the boy was reoperated three months later followed by proton irradiation with 50 Gy in 28 fractions to the tumor bed. He needed substitution in all hormonal axes. He always felt hunger and kept gaining weight. Seventeen years old BMI was 38.3 kg/m². Semaglutide treatment was initiated and after 6 months on 2.4 mg per week BMI was 31.5 kg/m².

Patient 2: A girl diagnosed with CP 6 years old. The tumor was surgically removed, but due to relapse the girl was reoperated thrice, last time 11 years old. She needed substitution in all hormonal axes. She always felt hunger and sneaked out at night looking for food. Seventeen years old BMI was 44.8 kg/m². Semaglutide treatment was initiated and after 3 months on 2.4 mg per week BMI was 38.6 kg/m².

Patient 3: A girl diagnosed with CP 13 years old. The tumor was surgically removed. She needed substitution in all hormonal axes. Despite intensive lifestyle interventions she increased her weight. Fifteen years old her BMI was 32.4 kg/m². Semaglutide treatment was initiated and after 7 months on 2.4 mg per week BMI was 28.3 kg/m². All patients reported satiety feeling after a meal, less craving, increased physical activity, and better quality of life on semaglutide treatment.

Conclusion: The three patients with severe hypothalamic obesity after treatment for a craniopharyngioma reduced their BMI 12.7-17.8% after 3-7 months on semaglutide 2.4 mg once a week. Semaglutide appears promising in the treatment of hypothalamic obesity.