Endocrine Abstracts

Recognizing the site of origin of craniopharyngioma (CP) along the hypothalamus-pituitary axis according to pre-operative MR is helpful to understand its growth pattern in relation to hypothalamus, which is critical in the prediction of hypothalamic injury and planning of treatment. We retrospectively classified 29 CP according to MR pre-operative image study using modified classification of Tang et al. (Nature, 8:10215, 2018). According to its relation to pituitary stalk, CP were classified into two types: central and peripheral. Peripheral type was further subdivided into three subtypes: hypothalamic stalk, suprasellar stalk and intrasellar stalk. Central type and hypothalamic stalk peripheral subtype CP were considered to be of hypothalamic origin. We compared types of CP with the development of cognitive dysfunction and obesity after the treatment as markers of hypothalamic injury. Of the 29 CP examined in this study, five were classified as central type, and 24 as peripheral type. Twelve of peripheral type were subclassified as hypothalamic stalk CP, four as suprasellar stalk CP, and eight as intrasellar stalk CP. Cognitive dysfunction was found significantly more often in patients with central CP and hypothalamic stalk CP (3/5 and 4/12, respectively) in comparison to patients with suprasellar and intrasellar stalk CP who did not developed cognitive impairment (P=0.012). Obesity developed in 3 of 5 patients with central CP, 4 of 12 with hypothalamic stalk CP, 1 of 4 with suprasellar stalk CP, and 1 of 8 with intrasellar stalk CP, with no statistical difference between CP types. Our results showed that cognitive impairment as a marker of hypothalamic damage was found only in CPs of hypothalamic origin (classified as central and hypothalamic stalk CP). We conclude that this classification, based on preoperative MR findings, can predict hypothalamic damage. Suprasellar and intrasellar stalk CP may not involve the hypothalamus and therefore can be safely resected with no hypothalamic damage.