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The development of hypothalamic obesity in craniopharyngioma patients: A risk factor analysis in a well‐defined cohort
Author(s) -
Iersel Laura,
Meijneke Ruud W.H.,
Schoutenvan Meeteren Antoinette Y.N.,
Reneman Liesbeth,
Win Maartje M.,
Trotsenburg A.S. Paul,
Bisschop Peter H.,
Finken Martijn J.J.,
Vandertop W. Peter,
Furth Wouter R.,
Santen Hanneke M.
Publication year - 2018
Publication title -
pediatric blood and cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.116
H-Index - 105
eISSN - 1545-5017
pISSN - 1545-5009
DOI - 10.1002/pbc.26911
Subject(s) - medicine , craniopharyngioma , cohort , obesity , retrospective cohort study , risk factor , logistic regression , surgery , gastroenterology
Background Hypothalamic obesity (HO) is a major concern in patients treated for craniopharyngioma (CP). The influence of degree of resection on development of HO, event‐free survival (EFS), and neuroendocrine sequelae is an issue of debate. Procedure A retrospective cohort consisting of all CP patients treated between 2002 and 2012 in two university hospitals was identified. Multivariable logistic regression was used to study the associations between preoperative BMI, age at diagnosis, tumor volume, performed surgical resection, and presence of HO at follow‐up. Results Thirty‐five patients (21 children and 14 adults) were included. Median follow‐up time was 35.6 months (4.1–114.7). Four patients were obese at diagnosis. HO was present in 19 (54.3%) patients at last follow‐up of whom eight were morbidly obese. Thirteen (37.1%) patients underwent partial resection (PR) and 22 (62.9%) gross total resection (GTR). GTR was related to HO (OR 9.19, 95% CI 1.43–59.01), but for morbid HO, obesity at diagnosis was the only risk factor (OR 12.92, 95% CI 1.05–158.73). EFS in patients after GTR was 86%, compared to 42% after PR (log‐rank 9.2, P = 0.003). Adjuvant radiotherapy after PR improved EFS (log‐rank 8.2, P = 0.004). Panhypopituitarism, present in 15 patients, was mainly seen after GTR. Conclusions HO is less frequent after PR than after GTR, but PR cannot always prevent the development of morbid obesity in patients with obesity at diagnosis. PR reduces the occurrence of panhypopituitarism. When developing a treatment algorithm, all these factors should be considered.