Endocrine Abstracts

Suprasellar craniopharyngiomas (CF) are characterised by a high incidence of involvement of the third ventricle, which determines the risk of hypothalamic obesity (HO). There are no unified diagnostic criteria for HO and its effective treatment. The assessment of pre- and postoperative hypothalamic damage is necessary for the choice of surgical strategy and early therapeutic intervention.

Objective: To estimate the incidence and extent of weight gain in adult patients with CF depending on the degree of hypothalamic involvement.

Methods: 58 patients older than 18 years (30 women, 28 men), the median age 42 (range 29–54). All patients were operated, the degree of hypothalamic involvement was assessed on the basis of preoperative MRI and intraoperative data. The criterion for HO was a weight gain of 10 kg or more over a period of 6 months. Body weight was assessed before and after 3,6,12 months after surgery. Body mass index >25.0 for overweight (OW) and >30.0 for obesity (OB). By localizing tumor patients were divided into 2 groups: 1 – at “pituitary stalk” without penetration into the third ventricular cavity (24), 2 – combined “the pituitary stalk” and ventricular (34).

Results: In group 1: before the surgery OW in 25% cases (6), OB in 25% (6), weight gain was observed in 12% cases (3), the m?dian 5 kg (4–5). Total removal in 79% cases (19), of which in 12 patient the tumor was adhering to the third ventricle floor. After the surgery: OW in 25% cases (6), OB in 45%(11), HO developed in 30%(7), weight gain the m?dian 22 kg (15–27). In group 2: before the surgery OW in 32% cases (11), OB in 41%(14), HO in 29%(7), weight gain the m?dian 16 kg (14–18). Total removal in 61% cases (21). After the surgery: OW in 26% cases (9), OB in 64% (22), HO in 38%(13), weight gain m?dian 15 kg (12–25), of which only 2 had preoperative weight gain >10 kg. In both groups weight gain after surgery was observed within the first 6 months.

Conclusion: Preoperative HO was observed only among patients in 2 group, which in combination with MRI data can be regarded as an indication of hypothalamic involvement. Damage to the hypothalamus, due to tumor invasion or surgical treatment, causes weight gain of the same degree. After surgery, patients with a tumor with hypothalamic involvement but without pre-operative weight gain are at risk for HO.