Bariatric Surgery for Hypothalamic Obesity in Craniopharyngioma Patients: A Retrospective, Matched Case-Control Study

Abstract

Context Craniopharyngioma is a sellar tumor associated with high rates of pituitary deficiencies (~98%) and hypothalamic obesity (~50%). Objective To determine the efficacy regarding long-term weight loss after bariatric surgery in obese craniopharyngioma patients with hypothalamic dysfunction. Design Retrospective case control study. Setting Multicenter international study. Patients and participants Obese craniopharyngioma patients (N = 16; of which 12 women) with a history of bariatric surgery [12 Roux-en-Y gastric bypass, 4 sleeve gastrectomy; median age of 21 years (range 15-52), median follow-up 5.2 years (range 2.0-11.3)] and age/sex/surgery/BMI-matched obese controls (N = 155). Main outcome measures Weight loss and obesity-related comorbidities up to 5 years after bariatric surgery were compared and changes in hormonal replacement therapy evaluated. Results Mean weight loss at 5-year follow-up was 22.0% (95% CI 16.1, 27.8) in patients versus 29.5% (28.0, 30.9) in controls (P = 0.02), which was less after Roux-en-Y gastric bypass (22.7% [16.9, 28.5] vs. 32.0% [30.4, 33.6]; P = 0.003) but at a similar level after sleeve gastrectomy (21.7% [–1.8, 45.2] vs. 21.8% [18.2, 25.5]; P = 0.96). No major changes in endocrine replacement therapy were observed after surgery. One patient died (unknown cause). One patient had long-term absorptive problems. Conclusions Obese patients with craniopharyngioma had a substantial mean weight loss of 22% at 5-year follow-up after bariatric surgery, independent of type of bariatric surgery procedure. Weight loss was lower than in obese controls after Roux-en-Y gastric bypass. Bariatric surgery appears effective and relatively safe in the treatment of obese craniopharyngioma patients.

A Survey of Patient-Relevant Outcomes in Pediatric Craniopharyngioma: Focus on Hypothalamic Obesity

“…Notably this study was completed prior to FDA approval of a GLP-1 receptor agonist (liraglutide) for obesity in adolescents as young as 12 years of age. Also, although there is some evidence of efficacy in the overall small number of pediatric patients treated with bariatric surgery, we did not focus on this option in our survey ( 24 ). The role for bariatric surgery and the expected course deserves additional attention in this cohort, in particular its role for addressing comorbidities.…”

Randomized controlled trial of Tesomet for weight loss in hypothalamic obesity

“…Bariatric surgery as treatment for hypothalamic obesity was mostly investigated in case reports or small case–control studies and commonly involved Roux-en-Y gastric bypass, laparoscopic gastric banding, and sleeve gastrectomy. Van Santen et al recently reported that weight loss 5 years after bariatric surgery was less effective in hypothalamic obesity than in general obesity for Roux-en-Y gastric bypass (−22.7% and −32%, respectively, P = 0.003) but comparable for sleeve gastrectomy (−21.7% and −21.8%, respectively, P = 0.96) ( 14 ). Following bariatric surgery, generally minor changes in the need for hormonal replacement therapies were reported ( 14 , 44 , 45 ).…”

“…Van Santen et al recently reported that weight loss 5 years after bariatric surgery was less effective in hypothalamic obesity than in general obesity for Roux-en-Y gastric bypass (−22.7% and −32%, respectively, P = 0.003) but comparable for sleeve gastrectomy (−21.7% and −21.8%, respectively, P = 0.96) ( 14 ). Following bariatric surgery, generally minor changes in the need for hormonal replacement therapies were reported ( 14 , 44 , 45 ). Importantly, cases of adrenal crises and acute aggravation of diabetes insipidus were reported, which is probably explained by altered post-operative drug absorption ( 7 , 15 , 46 ).…”

“…There are currently no approved pharmacological treatments for hypothalamic obesity, and conventional weight management (diet and lifestyle modifications) remains mostly ineffective ( 12 , 13 ). Bariatric surgery may produce sustained weight loss in some patients ( 14 , 15 ) but is not an option for most because long-term safety and malabsorption issues may present a challenge ( 16 , 17 ).…”

Approach to the Patient: Management of Pituitary Hormone Replacement Through Transition

“…No medical treatments have been shown to achieve sustained weight loss in hypothalamic obesity although GLP-1 agonists may be of use ( 76 ). Bariatric surgery can help some patients, as described in a small cohort study by van Santen et al ( 77 ), but is probably not suitable for all patients ( 78 ). No medication is available for the other features of HD and treatment is largely symptomatic.…”