Endocrine Abstracts

Background: Obesity is a common sequel to tumours of the hypothalamic region and their treatment. Weight gain occurs at a rate faster than any expected age-related increase and despite treated hormone deficiencies.

Methods: Retrospective review of patients with hypothalamic-pituitary tumours attending a large neuroendocrine clinic in UK.

Results: Initial review in 2002 had identified 42 adults with tumours causing hypothalamic damage. 24% were obese [body mass index (BMI) > 30 kg/m²] at diagnosis, but after a median of 5 years follow-up, 52% had become obese and 24% had BMI > 35. Review 7 years on, in 2009, of 68 patients (40 from original cohort, 28 new patients) demonstrated increased weight from diagnosis (mean BMI 28.4) to latest follow-up (mean BMI 33.4). Weight gain was fastest in the first year after diagnosis and treatment of the hypothalamic tumour, with a mean increase in BMI of 2.1 kg/m². Despite increased awareness since 2002 of the problem of obesity in these patients, and advice on weight management, dietetic review and anti-obesity treatments consistently offered in clinic (15 treated with orlistat, 4 had multiple weight loss medications; 5 attended a multidisciplinary hospital weight management clinic), the prevalence of obesity in this group further increased, with 61% of patients now obese and 37% with BMI >35. Moreover, other cardiovascular risk factors are highly prevalent: 57% have treated dyslipidaemia, mean cholesterol is 5.3 (range 2.6–9.8) mmol/l, 29% have hypertension, 13.8% type 2 diabetes; 11% have ischaemic heart disease and 3.7% cerebrovascular disease.

Conclusions: Weight gain and obesity are common, difficult to prevent and treat in patients with hypothalamic damage and the high prevalence of other cardiovascular risk factors and diseases can further contribute to increased morbidity and mortality. Increased awareness, active monitoring and aggressive treatment of these complications by clinicians is vital.