Endocrine Abstracts

The treatment of craniopharyngiomas is associated with long-term morbidity. Although histological benign, intrinsic aggressive biological properties of craniopharyngioma, such as invasion of surrounding tissues, apparently preclude an indolent course. Cardio- and cerebrovascular mortality risk in craniopharyngioma patients is approximately three fold increased. This risk seems to be even greater in estrogen-deficient premenopausal women. In addition, there is a high prevalence of features of the metabolic syndrome, such as type 2 diabetes mellitus, obesity and dyslipidaemia, when compared to normative data. Long-term follow-up studies all involve retrospective historical cohorts. The potential role of treatment modalities and hypopituitarism to the enhanced cardiovascular morbidity, is discussed. Then, the question arises as to the mechanism(s) involved in the explanation for the increased prevalence of cardiometabolic complications in these patients. One of these explanations is irreversible hypothalamic dysfunction. Evolution has provided us with powerful tools to keep our internal environment stable by synchronizing activity and rest to the day/night cycle by means of biological clock mechanisms. The nuclei within the hypothalamus are crucial in integrating and conveying the different signals, informing the brain of the internal and external environment. Considering the large proportion of patients with damage to the optic nerves, it is hypothesized that craniopharyngiomas and/or the effects of treatment may result in damage to the suprachiasmatic hypothalamic nucleus. This may result in altered regulation of central clock mechanisms, which predisposes to alterations in metabolism. In addition, the possibility of damage to other hypothalamic nuclei involved in the integrative physiology of metabolism cannot be excluded. Hypothalamic damage thus may have contributed to the observed morbidity but direct clinical evidence is not yet available. Patients treated for Craniopharyngioma have excessive long-term multisystem morbidity and mortality. Besides appropriate endocrine replacement, especially estrogen replacement in premenopausal females, intensive control of glucose, lipids, blood pressure and weight should be achieved, as in any other patient with increased risk for cardiovascular disease.