Growth and endocrine sequelae of craniopharyngioma.

DeVile, Catherine; Grant, D B; Hayward, Richard; Stanhope, R

doi:10.1136/adc.75.2.108

Cited by 187 publications

(136 citation statements)

References 27 publications

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“…The primary goal is not to avoid hypopituitarism, but to avoid further hypothalamic damage (3). Due to its growth and/or treatment, hypopituitarism is seen in the vast majority of cases, and obesity due to hypothalamic involvement in up to half of the patients (4,5). Women and men are equally affected and about 40% of cases are seen in patients < 16 years of age (2).…”

Section: Introductionmentioning

confidence: 99%

Endocrine aspects and sequel in patients with craniopharyngioma

Erfurth

2015

Journal of Pediatric Endocrinology and Metabolism

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A craniopharyngioma (CP) is an embryonic malformation of the sellar and parasellar region. The annual incidence is 0.5-2.0 cases/million per year and approximately 60% of CP is seen in adulthood. The therapy of choice is surgery, followed by cranial radiotherapy in about half of the patients. Typical initial manifestations at diagnosis in children are symptoms of elevated intracranial pressure, visual disturbances and hypopituitarism. CPs have the highest mortality of all pituitary tumours. The standardised overall mortality rate varies from 2.88 to 9.28 in cohort studies. Adults with CP have a 3-19-fold higher cardiovascular mortality in comparison to the general population. Women with CP have an even higher risk. The long-term morbidity is substantial with hypopituitarism, increased cardiovascular risk, hypothalamic damage, visual and neurological deficits, reduced bone health and reduction in quality of life and cognitive function.

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Section: Introductionmentioning

confidence: 99%

Endocrine aspects and sequel in patients with craniopharyngioma

Erfurth

2015

Journal of Pediatric Endocrinology and Metabolism

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“…Morbidity is significant even at initial diagnosis in patients with a craniopharyngioma (7)(8)(9). This may include symptoms and signs related to raised intracranial pressure (present in O50%), encroachment of the tumour on the optic nerves resulting in visual failure (30-60%), hypothalamic involvement (up to 30%), endocrine manifestations such as anterior hypopituitarism (20-30%) and DI (9-17%), and in some cases, chemical meningitis following cyst rupture.…”

Section: Discussionmentioning

confidence: 99%

“…Hypothalamic symptoms can complicate management and may involve disturbance of mood, temperature control and sleep. For the endocrinologist, disturbances of thirst and appetite are the most challenging aspects of management (7,13,14). Hypodipsia or adipsia complicates the management of DI and hyperphagia results in increasing levels of obesity from damage to the ventromedial nucleus in the hypothalamus.…”

Section: Discussionmentioning

confidence: 99%

‘Do no harm’: management of craniopharyngioma

Gleeson¹,

Amin²,

Maghnie

2008

European Journal of Endocrinology

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Craniopharyngioma management is challenging. Although histology is benign, the tumour can be clinically aggressive with local invasion and frequent recurrences. Extensive morbidity may be present at diagnosis and furthermore, occurs as a consequence of neurosurgery and radiotherapy. Hypothalamic symptoms can have a devastating effect on quality of life and may reduce life expectancy. This case highlights both the challenge of managing hyperphagia and morbid obesity and the importance of initial treatment preserving existing hypothalamic function and the need to avoid tumour recurrence and further surgery.A 11-year old boy presented with hydrocephalus secondary to a craniopharyngioma (he had visual failure and hypopituitarism but few hypothalamic symptoms). He underwent radical resection followed by radiotherapy. Following this treatment, he developed psychological and behavioural problems and hyperphagia. Weight gain in the first year (an increase from C1.4 to C3.7 S.D.) resulted in poor mobility and a fall which caused a slipped femoral epiphysis. In the next year, there was a 6-month period of unexpected weight loss (C4.2 to C3.8 S.D.) that culminated in emergency treatment for diabetic ketoacidosis secondary to severe insulin resistance. He developed a left hemiplegia, and a subsequent cerebral angiogram identified multiple stenoses of the Circle of Willis with a Moyamoya appearance secondary to radiotherapy. Weight gain has continued (C3.8 to C5.5 S.D.) so that bariatric surgery is a management option.European Journal of Endocrinology 159 S95-S99

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“…Zhou et al 15) reported that the incidence of diabetes insipidus before and after surgery was 52% and 92%, respectively. Devile et al 8) reported that the incidence of diabetes insipidus depended on the extent of tumor removal, and that the incidence of diabetes insipidus after limited surgery was 6%, but it was as high as 70% to 90% after aggressive surgery. At present, sellar region pathologies may be completely removed with the help of modern neuroimaging and microneurosurgical techniques, but how to guard patients from endocrine abnormalities after this removal remains a challenge to neurosurgeons worldwide.…”

Section: Discussionmentioning

confidence: 99%

“…The connecting pituitary stalk passes inferiorly through an opening in the dura, allowing delivery of hypothalamic peptides to the pituitary gland. The pituitary stalk contains the fibers of the neurohypophysis, which connect the posterior lobe to the supraoptic and paraventricular nuclei of the hypothalamus, and the portal venous system, transmitting hypothalamic pep-tides that control anterior lobe secretion via the median eminence 5,7,8) . The objective of the current study was to investigate the relationship between the pituitary stalk and its surrounding structures such as the diaphragma sellae, the tuberculum sellae, and the dorsum sellae and chiasmatic cistern in human cadaver specimens.…”

Section: Introductionmentioning

confidence: 99%

Characterization of the Anatomic Location of the Pituitary Stalk and Its Relationship to the Dorsum Sellae, Tuberculum Sellae and Chiasmatic Cistern

Gülşen

Dinç

Ünal

et al. 2010

J Korean Neurosurg Soc

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Objective :The normal anatomic relationships characteristic of the pituitary stalk area were previously thought to involve only one location. The purpose of this study was to re-evaluate the anatomic location of the pituitary stalk and possible varying locations in relation to the tuberculum sellae and dorsum sellae using morphometric evaluation and anatomic dissection of human cadaveric specimens. The surgical implications of the variations are discussed. Methods : The calvaria were removed via routine autopsy dissections, and the brains were removed from the skull while preserving the pituitary stalk. The diaphragma sellae, tuberculum sellae, and the location of the pituitary stalk were examined in 60 human cadaveric heads obtained from fresh adult cadavers. Empty sellae were excluded. Results : The openings of the diaphragma sellae averaged 6.62 ± 1.606 mm (range, 3-9 mm). The distance between the tuberculum sellae and the posterior part of the pituitary stalk was 1 to 8 mm. The upper face of the diaphragma sellae appeared flat in 26 (43%), concave in 24 (40%), and convex in 6 cases (10%), with a prominent tuberculum sellae in 4 cases (7%). The location of the chiasm was normal in 47 cases (78%), with a prefixed chiasm in 3 cases (5%) and a postfixed chiasm (17%) in the 10 cases. Four cadaver specimens had prominent tuberculum sellae and other parameters were not evaluated. Conclusion : When opening the chiasmatic cistern, neurosurgeons should be aware about the relationship between the pituitary stalk and the surrounding structures to prevent inadvertent injury to the pituitary stalk.

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Growth and endocrine sequelae of craniopharyngioma.

Cited by 187 publications

References 27 publications

Endocrine aspects and sequel in patients with craniopharyngioma

Endocrine aspects and sequel in patients with craniopharyngioma

‘Do no harm’: management of craniopharyngioma

Characterization of the Anatomic Location of the Pituitary Stalk and Its Relationship to the Dorsum Sellae, Tuberculum Sellae and Chiasmatic Cistern

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