Endocrine Abstracts

Hypothesis: We hypothesised that damage to the hypothalamus by local tumour, surgical treatment, or irradiation might involve the suprachiasmatic nucleus and thereby melatonin secretion, leading to disturbed circadian function and clinical manifestations such as daytime sleepiness and fatigue in craniopharyngeoma patients.

Objective: We aimed to assess the influence of craniopharyngiomas and their treatment on melatonin secretion, sleep pattern, sleep quality, fatigue, and sleepiness.

Subjects and measures: We included 15 patients with craniopharynioma and 15 gender, age, and BMI matched healthy controls. Salivary melatonin and cortisol were measured over a 24 h-period. Sleep–wake patterns were characterized by two weeks of actigraphy recordings and sleep diaries. Sleepiness, fatigue, sleep quality, and general health were assessed by the four questionnaires: i) ‘Multidimensional Fatigue Inventory’; ii) ‘Pittsburgh Sleep Quality Index’; iii) Epworth Sleepiness Score; and iv) ‘Short Form-36’.

Results: The patients had lower general health (P=0.01), increased mental fatigue (P=0.05), increased daytime dysfunction (P=0.05), increased sleep latency (P=0.04), and tended to have increased daytime sleepiness, general fatigue, and impaired sleep quality compared to healthy controls (all P≤0.08). Patients had lower AUC-melatonin (P=0.04) and higher evening cortisol concentrations. Low midnight melatonin was associated with reduced sleep time (P=0.03) and efficiency (P=0.02), and borderline to increased sleepiness, impaired sleep quality, and physical health (P≤0.08). High midnight cortisol levels were associated with an increased number of awakenings (P=0.02) and sleep time (P=0.07). Midnight melatonin remained independently related to sleep time after adjustment for cortisol.

Conclusion: Our data indicated a relationship between low midnight melatonin and reduced sleep time, impaired sleep efficiency, and reduced physical activity in craniopharyngioma patients. This might be due to the influence of craniopharyngioma on the sleep regulatory nuclei.