Endocrine Abstracts

Craniopharyngiomas are rare tumors that in a high percentage of patients leads to damage of periventricular nucleus and suprachiasmatic nucleus, what leads to the development of hypothalamic obesity. Hypotalamic obesity is associated with numerous metabolic disorders. Regardless of the numerous studies of new therapeutic approaches, there is still no official approved effective (phramacological or bariatric) treatment for hypotalamic obesity. Liraglutide is an GLP-1 analogue that stimulates insulin released from beta cells of pancreas after eating, suppresses glucagon secretion and induce the weight loss. It is proposed that liraglutide has the peripheral and central effects in the maintenance of weight loss, but the clear mechanism of liraglutide action in CNS is still lacking. We present the case of patient who was diagnosed with craniopharyngioma as a 31 year old after sudden headache attack, followed by vomiting and unconsciousness. CT scan showed an expansive, suprasellar cystic tumor of dimension 25×27X21 mm with pituitary compression. Three years before diagnose of head tumor, the patient had a markedly enhanced appetite, causing the significant weight gain (>20 kg), and consequently the diagnose of arterial hypertension, hyperlipoproteinemia and type 2 diabetes. After the operation of the tumor was performed (PH: Craniopharyngeoma papillare, WHO grade I), endocrinological testing showed panhypopyuitarism and uncontroled diabetes (HbA1c 10.3%) with obesity (BMI 31.9 kg/m²). Replacement therapy with hydrorortisone, levothyroxine and testosterone were induced, but also the liraglutide as an antidiabetic drug. Three months later, the patient was well hormone substituted and has the better glycemic control (HbA1c 8.2%). Also, he lost 5 kilograms. Continuous loss of the weigt was obsserved 6 months. The plato was achieved on BMI 26.8 kg/m² by maximally tolerable dose of 1.2 mg/day of liraglutide, with well-control diabetes (HbA1c 7.3%). Further researches and results of randomized studies are needed in order to prove the efficacy of GLP-1 analogues as therapy for hypothalamic obesity.