Endocrine Abstracts

Background: Craniopharyngioma (CP) is a rare sellar or suprasellar epithelial tumour with a prevalence of approximately 2 per million and it occurs either in childhood between the ages of 5 and 14 years or in adulthood between the ages of 50 and 74 years. Histologically, CPs are divided into adamantinomatous, more prevalent in children, and papillary, more prevalent in adults. They are usually benign, but rare cases of malignant CPs have been reported. Clinical presentation is usually with symptoms of hypothalamic involvement such as weight gain, disturbance of circadian rhythm, disorders of temperature or thirst regulation, deficiencies of pituitary hormones, visual disturbances, or hydrocephalus. Neurosurgical resection is the treatment of choice but may need to be followed by radiotherapy in case of incomplete resection or tumour recurrence.

Aims: To assess the prevalence of post-operative medical complications in patients with CP in our institution and compare the findings with similar published series of patients from other centres.

Methods: We reviewed the documentation, correspondence, and biochemical records of 82 patients with CP who operated on between 2002 and 2022 at the University Hospital Southampton NHS Foundation Trust, UK. The patients had undergone either open or endoscopic resection of their CPs. Evaluated post-surgical outcomes included growth hormone deficiency, secondary hypothyroidism, hypocortisolism, hypogonadism, arginine vasopressin (AVP) deficiency, hypopituitarism (> 1 hormonal deficiency were present), hypothalamic damage and cerebrospinal fluid (CSF) leak.

Results: In our cohort, 16% of patients (13/82) had a hormonal deficiency at presentation. 62% of patients (51/82) developed new-onset hypocortisolism post-surgery (the commonest hormonal deficiency observed), followed by secondary hypothyroidism in 48% of patients (39/82; one case of late-onset secondary hypothyroidism due to pituitary radiotherapy). AVP deficiency was noted in 39% of patients (32/82), secondary hypogonadism in 32% of patients (26/82) and growth hormone deficiency in 24% of patients (20/82). 59% (48/82) had more than one hormonal deficiency i.e., hypopituitarism and 15% (12/82) had hypothalamic dysfunction manifesting as obesity, sleep-wake disturbance or delayed puberty. 45% (37/82) required adjuvant radiotherapy and in 18% of patients (15/82) the tumour recurred. The commonest surgical complication was CSF leak in about 10% of patients (8/82).

Conclusion: Post-operative hormonal deficiencies are very common in patients undergoing neurosurgical intervention for CPs and it is often a direct unavoidable consequence of surgery in patients without endocrine anomalies at their initial presentation. The findings in our cohort of 82 patients are consistent with similar published series in the literature.