Endocrine Abstracts

Hypothalamic obesity has major impact on prognosis and quality of life (QoL) in childhood craniopharyngioma (CP). The pathogenic relevance of initial hypothalamic involvement versus treatment-related hypothalamic lesions is a matter of controversy.

One hundred and twenty patients were recruited prospectively during 2001 and 2007 and evaluated after 3 years of follow-up. Body mass index (BMI) and QoL at diagnosis and 36 mo after diagnosis were analyzed based on reference assessment of tumour localization and post-surgical hypothalamic lesions using a standardized grading system (no, anterior, posterior involvement/lesion). Treatment was analyzed regarding neurosurgical strategy of 50 participating neurosurgical centres and the centre sizes. Based on patient load during the 6-year recruitment period, participating centres were categorized as small (1 pt/6 years), middle (2–5 pts/6 years) or large-sized centres (>5 pts/6 years).

BMI SDS at diagnosis was similar in patients with or without hypothalamic involvement. Surgical lesions of anterior and posterior hypothalamic areas were associated with higher increases in BMI SDS during 36 mo post-diagnosis compared to patients without or only anterior lesion (+1.8 BMISD, P=0.033, +2.1 BMISD; P=0.011), negatively impacting QoL in patients with posterior hypothalamic lesions. Surgical strategies varied between the 50 neurosurgical centres (3 large, 24 middle, 23 small centres). Patients treated in small centres presented with a higher rate of hypothalamic involvement compared to middle and large-sized centres. Treatment in large centres was less radical, the rates of complete resection and hypothalamic surgical lesions lower than those of middle-sized and small centres. However, a multivariable analysis showed that pre-operative hypothalamic involvement was the only independent risk factor for severe obesity (P=0.002).

Radical strategies leading to posterior hypothalamic lesions are not recommended due to potential to exacerbate hypothalamic obesity and impaired QoL. Because our results show that initial hypothalamic involvement has an a priori effect on the clinical course, our recommendations are based on recognizing CP as a chronic disease.

Declaration of interest: The authors declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research project.

Funding: This work was supported, however funding details are unavailable.