Endocrine Abstracts

Introduction: Craniopharyngioma is an insidious disease that leads to profound comorbidities. Outcomes of the disease have been studied in depth, but there is little data comparing pituitary comorbidities of cases diagnosed in recent years opposed to before. We hypothesized that advances in endocrinologic diagnostics and neurosurgery have led to a lower degree of comorbidities.

Methods: We investigated 54 patients with adult-onset craniopharyngioma (28 male, mean age 40.4±14.2 years) diagnosed between 1965 and 2009 from our institutions’ records. We split our cohort in two groups: cases diagnosed after 1997 (‘recent’) and until that year (‘historic’). We compared the presence of pituitary insufficiency between both groups using chi-squared statistics.

Results: Follow-up was 20.0±9.6 and 6.6±4.1 years for historic and recent diagnoses respectively. Both groups (historic: n=26, mean age 34.3±12.3 years; recent: n=28, age 46.1±13.5) did not differ in terms of gender distribution (historic: 14 female, 12 male; recent: 18 femals, 10 males), surgical approach, radiation therapy, pituitary insufficiencies and tumor compression signs before therapy. The historic group had a significantly higher proportion of extrasellar tumor extension (68.2 vs 30.8%, P=0.01, OR=4.8). At last follow-up the historic group had significantly more frequent insufficiencies of the hypothalamic-pituitary axis concerning the adrenal (96.2 vs 60.7%, P=0.002, OR=16.2), thyroid (92.3 vs 67.9%, P=0.026, OR=5.7), somatotropic (92.3vs 71.4%, P=0.048, OR=4.8), and gonadal (92.3 vs 64.3%, P=0.013, OR=6.7) axis. The frequency of diabetes insipidus did not differ between groups (P=1.0). Visual field defects were significantly more common in the historic group (66.7 vs 39.3%, P=0.049, OR=3.1).

Conclusion: We found significant differences in post-operative pituitary insufficiencies and visual field defects between patients diagnosed before and after 1997. This might be a consequence of improved surgical approach. Furthermore, differences in tumor extension could be due to improvements in diagnostics and earlier treatment of craniopharyngioma.