ECE2015 Eposter Presentations Pituitary: clinical (121 abstracts)
No evidence of impaired oral hormone substitution after gastric bypass surgery in patients with morbid hypothalamic obesity and hypopituitarism secondary to craniopharyngioma
Peter Wolf 1 , Yvonne Winhofer 1 , Sabina Smajis 1 , Renate Kruschitz 1 , Karin Schindler 1 , Alois Gessl 1 , Greisa Vila 1 , Wolfgang Raber 1 , Felix Langer 2 , Gerhard Prager 2 , Bernhard Ludvik 3 , Anton Luger 1 & Michael Krebs 1
1Division of Endocrinology and Metabolism, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria; 2Department of Surgery, Medical University of Vienna, Vienna, Austria; 3Division of Endocrinology, Diabetology and Nephrology, Department of Internal Medicine I, Rudolfstiftung, Vienna, Austria.
Background: Craniopharyngiomas (CP) are benign brain tumours presenting in childhood treated by tumour resection together with radiotherapy. In about half of the cured patients hypothalamic damage leading to eating disorders and obesity as well as to hypopituitarism, necessitating consequent hormone substitution therapy, is observed. Bariatric surgery is an efficient treatment strategy for morbid obesity. However, so far it is unknown, whether oral hormone substitution is hampered by impaired intestinal absorption, leading to severe hypopituitarism or adrenal insufficiency.
Methods: Four CP patients with hypopituitarism and morbid obesity treated by gastric bypass surgery were included in this retrospective analysis. Dosage of hormone substitution, hormonal blood concentrations, adverse effects of impaired drug absorption, and anthropometric characteristics were investigated pre and 3–12 months post operatively.
Results: In all CP patients (3W/1M; BMIbasal 49±7 kg/m2) gastric bypass resulted in distinct weight loss (−35±27 kg). In follow-up examinations mean concentration of fT4 increased (fT4 basal 0.9±0.31 ng/dl vs fT4 follow up 1.28±0.29 ng/dl). No patient developed any signs of adrenal insufficiency postoperatively. Mean daily dosage of oral thyroid hormone substitution (levothyroxinebasal 156±44 μg/day vs levothyroxinefollow up 150±30 μg/day) and hydrocortisone (hydrocortisonebasal 29±12 mg/day vs hydrocortisonefollow up 26±2 mg/day) was unchanged. Mean IGF1 concentration decreased after weight loss (IGF1basal 217±93 ng/ml vs IGF1follow up 111±36 ng/ml), whereas daily growth-hormone substitution was slightly increased (somatotropinbasal 0.9±0.5 mg/day vs somatotropinfollow up 1.0±0.4 mg/day). Minirin dosage and daily fluid intake remained unchanged.
Discussion: Our results in n=4 CP patients suffering from hypopituitarism indicate that oral hormone substitution therapy is not impaired following gastric bypass operation, probably making it a safe and considerable treatment strategy in patients suffering from hypothalamic obesity.
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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