Endocrine Abstracts

Objectives: Craniopharyngioma is a benign tumour of the suprasellar region that is associated with increased morbidity and mortality in comparison to other causes of hypopituitarism. We aimed to establish the mode of presentation, investigations, treatment outcomes, mortality and subjective improvement in patients with craniopharyngioma in a single institution over 10 years.

Design: Retrospective case notes review of patients with Craniopharyngioma on endocrine register between 2000 and 2010. Clinical records of eligible patients were reviewed and information regarding clinical presentation, medical and surgical management and post treatment outcomes were extracted and collated.

Results: Symptoms at presentation: the commonest presenting symptoms were headache (79%) and visual impairment (75%). Other symptoms were vomiting (27%), cognitive dysfunction (3.4%), weight gain (34.4%), reduced conscious level (3.4%), poor energy level (68.9%), somnolence (13.7%), loss of libido (13%) and polyuria (13.7%).

Surgical outcomes: Gross total resection was achieved in 41.3% but was curative in only 20%. The remaining 80% required further surgical and/or radio therapeutic intervention. Reduction in tumour size was achieved in 86% of patients. CSF leak was 18% post surgical intervention. Visual field were fully recovered in only 27.8% and partially recovered in 26% of patients after surgery and radiotherapy. Endocrine out comes: multiple pituitary hormone deficiency evolved in all patients over time, the commonest were hypothyroidism (79%) and ACTH deficiency (72%). Other deficiencies were gonadotrophins (45%), diabetes insipidus (41%), and GH def (14%). Although neurocoagnitive, psychological and behavioural problems were noted for some patients, only 20% of patients were formally assessed. Subjective improvement in condition

It was assessed by follow up clinic letters that 59% patients have reported improvement in their condition but 18% of these patients got worse after intervention.

Mortality: All cause mortality was 31%. Tumour related mortality was 25%.

Conclusions: Craniopharyngioma is associated with significant long-term morbidity. Attention to an integrated care pathway that includes standardised neurocognitive and psychological and behavioural assessment would facilitate early appropriate intervention and support leading to an improved quality of life of patients with craniopharygioma.