Endocrine Abstracts

Introduction: Craniopharyngiomas are benign tumors in the suprasellar region that have encouraging survival rates between 77-93%. Unfortunately, long-term sequelae are frequent, resulting in excessive endocrine and metabolic morbidity, including premature cardiovascular disease and reduced bone health.

Objective: To determine the prevalence of unfavorable body composition and low bone mineral density (BMD) in patients with craniopharyngioma.

Methods: We studied a retrospective cohort of 93 Dutch and Swedish patients with craniopharyngioma, with at least two DXA-scans available. Outcomes of the first and last available DXA-scans (i.e. BMD, fat free mass index (FFMI), fat mass index (FMI), and body mass index (BMI)), were expressed as standard deviation scores (SDS) based on age, sex, and country of origin, and compared. The prevalence of osteopenia and osteoporosis (BMD SDS <-1) was also studied.

Results: The cohort included 47 females (51%) and 45 patients with childhood-onset (48%). Mean age at follow-up was 48 years (range 16-78), and mean time between DXA-scans was 10 years (range 0.08 - 23). At presentation, 55 patients had growth hormone deficiency (60%), 40 hypogonadotropic hypogonadism (44%), 58 ACTH insufficiency (63%), 64 TSH insufficiency (70%), and 49 diabetes insipidus (53%). At the first DXA-scan, mean SDS for BMD of the total body was -0.64 (range −4.21–2.40, n=72), mean SDS for femur neck was −0.60 (range −4.55–3.80, n=63), mean SDS for L2-L4 was −0.64 (range −3.50–3.90, n=66), mean SDS for FFMI 0.22 (range −2.98–3.97, n=59), mean SDS for FMI 1.50 (range −0.93–5.02, n=59), and mean SDS for BMI 1.53 (range −1.71–7.55, n=80). Over time, a significant increase was observed for SDS of BMD of the total body (mean difference 0.68 [95%CI 0.38-0.93; P<0.01]) and femur neck (mean difference 0.57 [95%CI 0.06-1.09; P=0.03]), SDS of the BMD of L2-L4 (mean difference 0.80 [95%CI 0.28-1.18; P<0.01]), and SDS of FFMI (mean difference 0.99 [95%CI 0.54-1.44; P<0.01]). Correspondingly, the prevalence of osteopenia and osteoporosis of L2-L4 declined from 47% to 34% (P<0.05).

Conclusions: Our cohort of craniopharyngioma patients is at risk of unfavorable body composition, reflected by high FMI and BMI, and of decreased bone health, reflected by negative mean values for SDS for BMD. SDS for BMD of L2-L4, femur neck, and total body, as well as FFMI increased over time, while SDS for BMI and FMI did not change. Also, the proportion of subjects with either osteoporosis or osteopenia in their lumbar spine decreased over time.