ECE2020 Audio ePoster Presentations Pituitary and Neuroendocrinology (217 abstracts)
Temporal trends in craniopharyngioma management and long term endocrine outcomes
Ziad HUSSEIN 1,2 , Nigel Glynn 3 , Niamh Martin 4 , Akram Alkrekshi 5 , Nigel Mendoza 6 , Nair Ramesh 6 , Katherine Mccullough 7 , Hani J Marcus 8 , Neil Dorward 8 , Joan Grieve 8 , Peirre Bouloux 9 , Maralyn Druce 3,10,11 & Stephanie Baldeweg 1,2
1University College Hospital, United Kingdom; 2University College London, United Kingdom; 3Street Bartholomew’s Hospital, United Kingdom; 4Imperial College London, United Kingdom; 5The MetroHealth System Campus of Case Western Reserve University, Cleveland, United States; 6Imperial College Healthcare NHS Trust, United Kingdom; 7Royal Surrey County Hospital, United Kingdom; 8National Hospital for Neurology and Neurosurgery, United Kingdom; 9University College London, Centre for Neuroendocrinology, Royal Free Campus, United Kingdom; 10Barts and The London School of Medicine and Dentistry, United Kingdom; 111Queen Mary University of London, United Kingdom
Background: The management of craniopharyngiomas remains controversial.
Objective: This study sought to examine temporal trends in the management of craniopharyngioma and their impact on long-term patient outcomes, with focus on endocrine consequences.
Methods: This was a cross sectional, multicentre study. Patients treated between 1951 and 2015 were identified and divided into four quartiles based on the date of initial surgery. Patients’ demographics, clinical presentation, treatment and outcomes were collected from retrospective medical record review. Temporal trends of the data were assessed during the period of the study.
Results: In total, 142 patients with both childhood onset craniopharyngioma (48/142; 33.8%) and adult onset disease (94/142; 66.1%) were recruited. Quartile one and four contained 36 patients each and quartile 2 and 3 contained 35 patients each. The median follow-up was 15.4 years (IQR 5.4–23.9 years). Variable data were available for the development of deficiency of individual pituitary hormones at latest clinical review. GH was impaired in 88% (119/135; 88%), 81% (99/1121; 81%) were gonadotrophin deficient, 86% (119/139; 86%) had secondary hypothyroidism, and 82% (116/141; 82%) were ACTH deficient. Permanent cranial diabetes insipidus occurred in 63% (87/139; 63%). The incidence of anterior panhypopituitarism reduced significantly across the quartiles during the time course of the study (P = 0.004). Anterior panhypopituitarism was not affected by treatment modality (surgery vs both surgery and radiotherapy) (P = 0.17). BMI data were available for 105 patients of which 88 (88/105; 84%) had raised BMI with a median BMI of 29.2 kg/m2 (IQR 25.5–34.6 kg/m2). There was no association between BMI and the age of diagnosis (P = 0.14) and no significant trend of BMI rate over the study period (P = 0.14). Across quartiles, there was a significant trend towards using transsphenoidal surgery and away from employing transcranial surgery (P < 0.0001). 86 patients (86/138; 62%) received post-operative radiotherapy, the overall use of radiotherapy was not statistically different among the four quartiles (P = 0.33). Craniopharyngioma recurred in 51 patients (51/142; 36%). There was no significant difference in the recurrence rate between the two age groups (P = 0.4) as well as the rate of recurrence during the time course of the study (P = 0.15).
Conclusion: The rate of hypopituitarism in craniopharyngioma has significantly improved reflecting the trend toward less aggressive neurosurgical techniques and high precision radiotherapy. Long term follow is required to provide appropriate care for the complex sequelae in patients with craniopharyngioma.
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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