Amy Rosenfeld1, Daniel Arrington2, Jeffrey Miller3, Micah Olson4, Annie Gieseking5, Michael Etzl5, Brian Harel6, Adrian Schembri7, Allen Kaplan8. 1. Center for Cancer and Blood Disorders, Phoenix Children's Hospital, Phoenix, Arizona. Electronic address: arosenfeld@phoenixchildrens.com. 2. Department of Neurology, University of Oklahoma, Oklahoma City, Oklahoma. 3. Division of Neuro-radiology, Phoenix Children's Hospital, Phoenix, Arizona. 4. Division of Endocrinology, Phoenix Children's Hospital, Phoenix, Arizona. 5. Center for Cancer and Blood Disorders, Phoenix Children's Hospital, Phoenix, Arizona. 6. Child Study Center, Yale University School of Medicine, New Haven, Connecticut; Cogstate Ltd, Melbourne, Australia. 7. Cogstate Ltd, Melbourne, Australia. 8. Division of Child Neurology, Phoenix Children's Hospital, Phoenix, Arizona.
Abstract
BACKGROUND: Although craniopharyngiomas are considered "benign" neoplasms by the World Health Organization classification, these tumors may create significant morbidity and mortality in patients. Hypothalamic obesity is a frequent complication of craniopharyngiomas and is refractory to current management options. PATIENTS/ METHODS: We reviewed 24 cases of craniopharyngiomas treated from 1992 to 2010 in patients <18 years of age regarding clinical presentation, neuroimaging, recurrence, morbidity, and mortality, with particular attention to hypothalamic obesity. RESULTS: Our cohort conformed to published data in regard to neuroimaging characteristics, and clinical findings in the areas of endocrine, visual, neurological, neurobehavioral, and hypothalamic domains. At last follow-up, 53% of our patients were overweight (8%) or obese (46%). Only 25% of our patients had a healthy body mass index. Contrasting these data with body mass indices at diagnosis, where 21% of patients were overweight and 17% were obese, we found that there was a significant trend towards obesity over time. A significant portion of our mortality appears to be related to complications of obesity. The Native American population in Arizona appears to have a statistically greater incidence of obesity in childhood. Despite our small sample size, 75% of our Native Americans were obese at last follow-up and accounted for 50% of the mortality. CONCLUSION: Hypothalamic obesity is a significant complication of craniopharyngiomas associated with increased mortality. The development of hypothalamic obesity is influenced by premorbid obesity, genetics, and therapy received, specifically radiation. Because of the intractability of hypothalamic obesity, improved understanding of neuroendocrine mechanisms, genomics, and newer antiobesity medications will be necessary to curb this significant complication.
BACKGROUND: Although craniopharyngiomas are considered "benign" neoplasms by the World Health Organization classification, these tumors may create significant morbidity and mortality in patients. Hypothalamic obesity is a frequent complication of craniopharyngiomas and is refractory to current management options. PATIENTS/ METHODS: We reviewed 24 cases of craniopharyngiomas treated from 1992 to 2010 in patients <18 years of age regarding clinical presentation, neuroimaging, recurrence, morbidity, and mortality, with particular attention to hypothalamic obesity. RESULTS: Our cohort conformed to published data in regard to neuroimaging characteristics, and clinical findings in the areas of endocrine, visual, neurological, neurobehavioral, and hypothalamic domains. At last follow-up, 53% of our patients were overweight (8%) or obese (46%). Only 25% of our patients had a healthy body mass index. Contrasting these data with body mass indices at diagnosis, where 21% of patients were overweight and 17% were obese, we found that there was a significant trend towards obesity over time. A significant portion of our mortality appears to be related to complications of obesity. The Native American population in Arizona appears to have a statistically greater incidence of obesity in childhood. Despite our small sample size, 75% of our Native Americans were obese at last follow-up and accounted for 50% of the mortality. CONCLUSION:Hypothalamic obesity is a significant complication of craniopharyngiomas associated with increased mortality. The development of hypothalamic obesity is influenced by premorbid obesity, genetics, and therapy received, specifically radiation. Because of the intractability of hypothalamic obesity, improved understanding of neuroendocrine mechanisms, genomics, and newer antiobesity medications will be necessary to curb this significant complication.
Authors: Andrew J Bishop; Brad Greenfield; Anita Mahajan; Arnold C Paulino; M Fatih Okcu; Pamela K Allen; Murali Chintagumpala; Lisa S Kahalley; Mary F McAleer; Susan L McGovern; William E Whitehead; David R Grosshans Journal: Int J Radiat Oncol Biol Phys Date: 2014-07-19 Impact factor: 7.038
Authors: Joshua Bakhsheshian; Diana L Jin; Ki-Eun Chang; Ben A Strickland; Dan A Donoho; Steven Cen; William J Mack; Frank Attenello; Eisha A Christian; Gabriel Zada Journal: Neurosurg Focus Date: 2016-12 Impact factor: 4.047