Endocrine Abstracts

Background: Adult craniopharyngioma (CP) patients without GH therapy exhibit high risk for cardiovascular disease (CVD) and mortality with a higher risk in women than in men. Approximately 50% of children treated for CP are obese at follow-up and hypothalamic damage seems to be a major cause. In GHD CP children GH treatment improves linear growth but does not ameliorate weight gain, but the impact of long-term GH therapy into adulthood is presently unknown.

The results from a cross-sectional study of 42 operated childhood onset (CO) CP patients on complete replacement therapy including GH will be presented. They were compared with population controls matched for age-, gender-, smoking, and residence for CVD risk, bone mineral density (BMD), basal metabolic rate (BMR), energy intake (EI), dietary intake and attitudes towards eating. The impact of disease related factors were also studied. Duration of GH therapy was 10 years in women and 12 years in men.

Results: Significant increases in BMI, fat mass, insulin and leptin were recorded in both male and female CP patients. CP women had increased CVD risk and the high BMI was the primary cause but long-term GH therapy was unsuccessful to affect this risk. Hypothalamic involvement by the tumour was superior to female gender risk in CVD risk prediction.

Despite increased fat mass, adequate muscle mass, physical activity and calcium intake when compared to controls, 45% of CO CP women, but not men, had z-scores below −2.0 SDS. Hypothalamic dysfunction with leptin resistance may have contributed.

The ratio EI/BMR was low in the patients with tumour growth into the hypothalamus. CP men had significantly higher percentage of energy from sugar and sweets compared to controls. CP women had significantly more percentage of energy from light meals and higher values on cognitive restraint and disinhibition compared to controls.

Conclusions: Women with CO CP have increased CVD risk and lower BMD in spite of long-term GH therapy. CO CP patients with hypothalamic involvement have low EI. Hypothalamic involvement predicts CVD risk and may contribute to low BMD and EI/BMR.