Cardiac remodeling in patients with childhood-onset craniopharyngioma—results of HIT-Endo and KRANIOPHARYNGEOM 2000/2007

Abstract

Hypothalamic obesity caused by childhood-onset craniopharyngioma results in long-term cardiovascular morbidity. Knowledge about clinical markers and risk factors for cardiovascular morbidity is scarce. A cross-sectional study on transthoracic echocardiographic parameters was performed to determine the associations with clinical and anthropometric parameters in 36 craniopharyngioma patients. BMI correlated with the thickness of interventricular septum in diastole (IVSd) (r = 0.604, p < 0.001) and left ventricular posterior wall thickness in diastole (LVPWd) (r = 0.460, p = 0.011). In multivariate analyses on risk factors for cardiac remodeling, sex hormone replacement therapy, BMI, and male gender were positively correlated with increased left ventricular internal diameter in diastole (LVIDd), R2 = 0.596, F = 10.323, p < 0.001. BMI and insulin resistance were selected as significant independent determinants of IVSd, produced R2 = 0.655, F = 29.441, p < 0.001. Due to a wide range of disease duration, 17 pediatric and 19 adult patients were analyzed separately. In the adult subgroup (age at study ≥ 18 years), BMI correlated with IVSd (r = 0.707, p = 0.003), LVPWd (r = 0.592, p = 0.020), and LVIDd (r = 0.571, p = 0.026). In the pediatric subgroup (age at study < 18 years), no correlation between transthoracic echocardiography (TTE) parameters and BMI was observed. Only LVIDd correlated with disease duration (r = 0.645, p < 0.001). All cardiac functions were within the normal range, indicating no association with functional impairments.Conclusion: Cardiac remodeling in patients with craniopharyngioma correlated with the degree of hypothalamic obesity, disease duration, sex hormone replacement therapy, male gender, and insulin resistance. As echocardiography has limited sensitivity in patients with obesity, further research on more sensitive techniques for cardiac diagnostics in craniopharyngioma patients is warranted. What is Known:•Long-term prognosis in survivors of craniopharyngioma is impaired by obesity and cardiovascular disease.•Associations between echocardiographic findings and clinical and anthropometric parameters after craniopharyngioma are not yet analyzed. What is New:•In patients with childhood-onset craniopharyngioma, cardiac remodeling was associated with hypothalamic obesity, duration of disease, male gender sex hormone replacement, and insulin resistance.•Due to reduced echocardiographic sensitivity caused by obesity-related technical limitations, more sensitive cardiac diagnostics should be considered.

Cerebral Infarction in Childhood-Onset Craniopharyngioma Patients: Results of KRANIOPHARYNGEOM 2007

“…Long-term outcome after CP is frequently impaired by morbidity due to hypothalamic obesity including cardiovascular (26) and neurovascular disease (27). Neurovascular complications such as CI in CP may result from injury to any of the major intracranial vessels and their branches, due to tumor location/infiltration and/or treatment-related lesions such as surgical injury, postoperative vasopasms or XRT-induced vessel damage.…”

Vascular Morbidity and Mortality in Craniopharyngioma Patients—A Scoping Review

“…One study comparing childhood- and adult-onset CP assessed the CVD risk, showing that adult-onset CP patients have a higher CVD risk than childhood-onset CP patients [ 23 ]. Multiple exposures were investigated: metabolic syndrome (MetS)/obesity [ 24 , 25 ], hypothalamic involvement (HI) [ 26 , 27 ], and growth hormone substitution therapy [ 28 ].…”

“…In their studies, Jung et al demonstrated that MetS and HI led to cardiac autonomic dysfunction, increasing the risk of cardiovascular events in CP patients [ 24 , 27 ]. In a multicenter cohort study of childhood-onset CP patients, a higher degree of obesity was correlated with increased left ventricular wall thickness [ 25 ]. Holmer et al found that not only was HI an important risk factor for CVD in CP patients, but female CP patients were also at a higher risk of experiencing a CVD event [ 26 ].…”

“…In the case reports identified for inclusion in this scoping review, FDCA and vasospasm were the most frequently observed neurovascular complications post-CP treatment. The included observational studies found abnormal echocardiographic values in CP patients associated with the degree of obesity [ 24 , 25 ]. CP survivors have higher circulatory disease-specific mortality and incidence compared to the studied general populations in several European countries [ 31 , 32 , 33 ].…”

Endocrine Disorder in Patients With Craniopharyngioma

“…In the related literature reports, the incidence of various hormone defects in patients with craniopharyngioma is slightly different. We searched PubMed for keywords such as craniopharyngioma, endocrine, and hormone, and the subjects were identified as children or adults, and 11 related literatures (2,8,10,11,14,20,(49)(50)(51)(52)(53) were obtained. We sorted out the literature to find out the incidence of endocrine dysfunction in craniopharyngioma (Table 1).…”