Endocrine Abstracts

Introduction: Craniopharyngioma (CP) is a benign tumor of the sellar/hypothalamic region. It is associated with excess mortality, obesity and endocrinopathies. These endocrinopathies may influence bone health, and increase the risk of fractures.

Methods: In this retrospective study, Dutch/Swedish patients with CP were included if data was available on final height (at age >18 years) or DXA-scan results. Information from the first and last DXA-scans were gathered (i.e. bone mineral density (BMD), T- and Z-scores). Data is presented as mean±standard deviation. Z-scores of final height were calculated (based on sex+country of origin).

Results: The cohort included 177 patients, of which 84 (47%) were females. Data was available on final height in 173 patients (98%) and of DXA-scan results in 117 patients (66%). At last follow-up (FU) (mean age 47±18 years), 149 patients had growth hormone deficiency (85%), 155 hypogonadotropic hypogonadism (88%), 146 ACTH insufficiency (83%), 162 TSH insufficiency (92%), and 113 diabetes insipidus (64%). TSH deficiency was significantly more common in male than in female patients (39% vs. 25%, P=0.042). At last FU, 69% used growth hormone replacement therapy and the mean daily hydrocortisone dose was 21±6 mg. BMD improving treatment was given to 33 patients (19%), which was higher in females (26% vs. 13%, P=0.03). Fractures in the total group occurred in 32 patients (19%). Fractures occurred more frequent in males than in females (29% vs. 10%, P=0.002) and more frequent in non-irradiated patients (13% vs. 26%, P=0.028). Mean time between DXA-scans was 10±7 years and mean difference in height was 3.0±10 cm. At first DXA-scan, mean T-score and Z-score for the BMD of total body, femur neck and L2–L4 were −0.1±1.5 and −0.5±1.4, −0.6±1.5 and −0.6±1.3, −0.7±1.6 and ±−0.7±1.6, respectively (no differences between sexes). Improvement in BMD occurred, expressed by mean change in T and Z-score of the total body (0.7±1.1, 0.7±1.0, P<0.001), Z-score of femur neck (0.6±1.9, P=0.03) and T- and Z-score of L2–L4 (0.9±1.6, 0.7±1.8, P<0.01). Mean final height for male and female subjects was 178.1±7.9 and 165.6±8.0 cm (Z-score Swedish subjects −1.0±4.3 and −0.1±1.2 (n=69)).

Conclusion: Fracture rate is high in patients with CP. BMD improves during the FU period. Males had more fractures than females without difference in BMD; they might be undertreated with bone health improving medication.