Risk Factors for Hypothalamic Obesity in Patients With Adult-Onset Craniopharyngioma: A Consecutive Series of 120 Cases

Wu, Wei; Sun, Quanya; Zhang, Xiaoming; Xiang, Boni; Zhang, Qiongyue; Miao, Qi; Wang, Yongfei; Li, Yiming; Ye, Hongying

doi:10.3389/fendo.2021.694213

Cited by 13 publications

(31 citation statements)

References 47 publications

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“…Furthermore, we included variables with p < 0.1 in stepwise multivariable logistic regression analysis to determine independent risk factors associated with postoperative HO (Table 3). In the present study, a ≥5% postoperative weight gain in 49.0% of patients in our cohort is higher than the 40.8% and 35.6% of patients reported in two recent studies focusing on adult-onset CP (11,14). One explanation is that patients undergoing reoperations were not excluded in their studies, which may increase preoperative weight and subsequently affect postoperative weight gain.…”

Section: Risk Factors Associated With Postoperative Hocontrasting

confidence: 77%

“…To differentiate HO from general obesity, HO was defined as having BMI ≥ 28.0 kg/m 2 , a standard for general obesity according to the Working Group on Obesity in China (21), and a significant increase in BMI (2 kg/m 2 during the first 6 months following surgery) after surgery or directly before surgery (within 1 year before surgery) (3,22). A postoperative weight change ≥5% was considered a clinically meaningful weight gain in previous studies (11,14,23,24).…”

Section: Endocrinological Evaluation and Follow-upmentioning

confidence: 99%

“…Puget et al (13) followed by reporting a similar grading system, which focused on individualized treatment strategies based on preoperative and postoperative assessments of hypothalamic damage. Although their grading systems were well associated with HO and postoperative weight gain in pediatric patients with CP, this association was not confirmed in patients with adult-onset CP by two recent studies (11,14). Moreover, Müller et al (8,15) presented a new three-tiered MRI grading system, which took posterior hypothalamic area into consideration.…”

Section: Introductionmentioning

confidence: 97%

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Postoperative hypothalamic damage predicts postoperative weight gain in patients with adult‐onset craniopharyngioma

Huang

et al. 2022

Obesity

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Objective: This study aimed to recapitulate the change trajectory of postoperative weight and investigate the association between postoperative hypothalamic damage and weight gain and hypothalamic obesity (HO) in patients with adult-onset craniopharyngioma. Methods: The data of 96 patients with surgically treated primary adult-onset craniopharyngioma were retrospectively analyzed. The association between postoperative hypothalamic damage based on magnetic resonance images or endoscopic observation and postoperative weight gain and HO was determined by multivariable logistic regression. Results: Forty-seven (49.0%) patients and 18 (18.8%) patients experienced clinically meaningful weight gain (≥5%) and HO at last follow-up, respectively. Postoperative weight significantly increased during the first 6 months following surgery, followed by stabilization. Both grade 2 postoperative hypothalamus damage, as evaluated by the magnetic resonance imaging classification system of Müller et al., and higher scores based on the Roth et al. hypothalamic lesion score were significantly associated with postoperative weight gain of ≥5% (p = 0.005 and p = 0.002) and with HO (p = 0.001 and p = 0.008). Additionally, bilateral hypothalamic injury as evaluated by the Hong et al. hypothalamic injury pattern based on endoscopic observation (p = 0.008) could predict postoperative weight gain ≥5%. Conclusions: Significant postoperative weight gain is common in patients with adultonset craniopharyngioma. Postoperative hypothalamic damage can predict clinically meaningful weight gain and HO.Compared with childhood CP, adult-onset CP has a distinct histological subtype, i.e., papillary CP almost exclusively occurs in adult groups (1,2,10). Given that studies focusing on adult-onset CP are sparse (11), it is unclear whether patients with adult-onset CP

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Section: Risk Factors Associated With Postoperative Hocontrasting

confidence: 77%

Section: Endocrinological Evaluation and Follow-upmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 97%

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Postoperative hypothalamic damage predicts postoperative weight gain in patients with adult‐onset craniopharyngioma

Huang

et al. 2022

Obesity

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“…In patients with craniopharyngioma, hypothalamic obesity occurs in up to 50% of patients ( 38 – 41 ) and up to twenty percent of patients with craniopharyngioma are obese at diagnosis ( 39 – 41 ), and this weight gain is irrespective of pituitary deficiency secondary to damage to the hypothalamic-pituitary axis. Higher preoperative BMI, radical tumour resection, larger preoperative tumour size, hypothalamic tumour invasion, adamantinomatous subtype, and familial predisposition to obesity are cited as factors that increase the risk of hypothalamic obesity ( 37 , 42 , 43 ). Rapid weight gain usually occurs within the first 3 years and often within the first year following surgical intervention, with surgical intervention increasing the prevalence of obesity in this patient group ( 38 , 43 ).…”

Section: Weight Gain In Children With Acquired Hypothalamic Damagementioning

confidence: 99%

Treatment of Acquired Hypothalamic Obesity: Now and the Future

Dimitri

2022

Front. Endocrinol.

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The hypothalamus is the centre of neuroendocrine regulation of energy homeostasis and appetite. Maldevelopment of, or damage to, the key hypothalamic nuclei disrupts the coordinated balance between energy intake and expenditure leading, to rapid and excessive weight gain. Hypothalamic obesity is compounded by a disruption of the hypothalamic-pituitary axis, sleep disruption, visual compromise, and neurological and vascular sequalae. Amongst suprasellar tumors, craniopharyngioma is the most common cause of acquired hypothalamic obesity, either directly or following surgical or radiotherapeutic intervention. At present, therapy is limited to strategies to manage obesity but with a modest and variable impact. Current approaches include optimizing pituitary hormone replacement, calorie restriction, increased energy expenditure through physical activity, behavioral interventions, pharmacotherapy and bariatric surgery. Current pharmacotherapeutic approaches include stimulants that increase energy consumption, anti-diabetic agents, hypothalamic–pituitary substitution therapy, octreotide, and methionine aminopeptidase 2 (MetAP2) inhibitors. Some pharmacological studies of hypothalamic obesity report weight loss or stabilization but reported intervention periods are short, and others report no effect. The impact of bariatric surgery on weight loss in hypothalamic obesity again is variable. Novel or combined approaches to manage hypothalamic obesity are thus required to achieve credible and sustained weight loss. Identifying etiological factors contributing hypothalamic obesity may lead to multi-faceted interventions targeting hyperphagia, insulin resistance, decreased energy expenditure, sleep disturbance, hypopituitarism and psychosocial morbidity. Placebo-controlled trials using current single, or combination therapies are required to determine the impact of therapeutic agents. A well-defined approach to defining the location of hypothalamic damage may support the use of future targeted therapies. Intranasal oxytocin is currently being investigated as an anorexogenic agent. Novel agents including those targeting pro-opimelanocortin-C and AgRP/NPY expressing neurons and the MC4 receptor may result in better outcomes. This article discusses the current challenges in the management of hypothalamic obesity in children and young people and future therapeutic approaches to increasing weight loss and quality of life in these patients.

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“…In fact, in these patients, leptin, a protein with an anorectic action that reduces the sense of hunger and increases energy expenditure, has an impaired function that is associated with increased insulin secretion, vagal tone, and adipogenesis ( 13 , 15 , 25 ). Moreover, a higher preoperative BMI seems to be an important risk factor for developing postoperative hypothalamic obesity ( 27 ).…”

Section: Discussionmentioning

confidence: 99%

Craniopharyngioma and Metabolic Syndrome: A 5-Year Follow-Up Single-Center Experience

et al. 2022

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Patients with craniopharyngioma often have comorbidities, such as obesity and hypopituitarism. These two conditions affect each other and worsen the quality of life of patients, which lead to a higher risk of morbidity and mortality. In addition, abdominal obesity, measured as waist circumference (WC), is together with other parameters [arterial hypertension, hyperglycemia, hypertriglyceridemia, and reduced levels of high-density lipoprotein (HDL) cholesterol], one of the components of metabolic syndrome (MS). Each one of these morbidities occurs in patients with craniopharyngioma more frequently than in the remaining population. On these bases, we evaluated metabolic parameters in patients with craniopharyngioma at the time of diagnosis and after a 5-year follow-up, which compares these data with those of age-, gender-, WC-, and body mass index (BMI)-matched controls. In addition, we evaluated the prevalence of MS according to IDF criteria (MS-IDF) and the prevalence of MS according to ATP III (MS-ATPIII) criteria in patients and controls at baseline and after 5 years. We recruited 20 patients with craniopharyngioma (age 38.5 ± 15 years, 10 M) and 20 age-, gender-, WC- and BMI-matched controls (age 34.16 ± 13.19 years, 10 M). In all patients and controls, we evaluated the following: anthropometric features [height, weight, BMI, WC, hip circumference (HC) and waist-to-hip ratio (WHR)], systolic blood pressure (SBP) and diastolic blood pressure (DBP), lipid profile [total cholesterol (TC), HDL, low-density lipoprotein (LDL) cholesterol, triglycerides (TG)], and blood glucose at baseline and after 5 years. The prevalence of MS, according to IDF and ATPIII criteria, was calculated in the two groups at baseline and after 5 years. According to our results, at baseline, patients with craniopharyngioma had a worse metabolic profile than controls and a higher prevalence of MS. Besides, at a 5-year follow-up, patients still had impaired metabolic characteristics and more frequent MS (according to IDF and ATPIII criteria) when compared to controls. These data confirm that MS in patients with craniopharyngioma is unresponsive to life-changing interventions and to a common pharmacological approach. Other factors may be involved in the evolution of these conditions; so, further studies are needed to establish the correct management of these patients.

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Risk Factors for Hypothalamic Obesity in Patients With Adult-Onset Craniopharyngioma: A Consecutive Series of 120 Cases

Cited by 13 publications

References 47 publications

Postoperative hypothalamic damage predicts postoperative weight gain in patients with adult‐onset craniopharyngioma

Postoperative hypothalamic damage predicts postoperative weight gain in patients with adult‐onset craniopharyngioma

Treatment of Acquired Hypothalamic Obesity: Now and the Future

Craniopharyngioma and Metabolic Syndrome: A 5-Year Follow-Up Single-Center Experience

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