Hypothalamic obesity in humans: what do we know and what can be done?

Abstract

Obesity is a common sequel to tumours of the hypothalamic region and their treatment with surgery and radiotherapy. The prevalence of hypothalamic obesity has been underestimated because it may take some years to develop, and the problem has been under-recognized by physicians. Weight gain results from damage to the ventromedial hypothalamus which leads, variously, to hyperphagia, a low metabolic rate, autonomic imbalance, growth hormone (GH) deficiency and various other problems that contribute to weight gain. However, with the exception of GH replacement, few clinical trials have evaluated significant numbers of patients and so the roles of various behavioural, dietary, pharmacological and obesity surgery approaches are controversial. Sufficient knowledge exists to identify those at high risk of hypothalamic obesity so that weight gain prevention approaches can be offered. In those who are already obese, we propose that the principal causal mechanisms in individual patients should be considered as a basis for guiding clinical management.

Evaluation of Carbohydrate and Lipid Metabolism and Risk of Obesity in Children after Brain Tumors Treatment

“…It relates mostly to patients treated for hypothalamic-pituitary tumors [8,14,[20][21][22]. As far as some authors are concerned, hypothalamic obesity may develop even some years after hypothalamic tumors management [22], though there are observations that first symptoms may be present shortly after surgery [23].…”

“…Meuric et al [24] evaluated patients with craniopharyngioma after extensive treatment and primary damage of hypothalamus and observed correlation between weight gain and increased insulin secretion. Hyperinsulinemia can develop either before the surgical treatment or after completed therapy [21][22][23][24][25]. The cause of increased insulin concentration in the serum indirectly explained animal studies.…”

The use of sibutramine in the management of obesity and related disorders: An update

“…124,125 Sibutramine might be useful in obese adolescents. 17,[126][127][128][129][130][131] In an early placebo-controlled trial in 82 obese adolescents receiving behavior therapy and sibutramine (starting dose 5 mg/day and uptitrated to 15 mg/day) the authors demonstrated a weight reduction significantly higher in the sibutramine group than in the placebo group (by 4.6 kg) after six months. 17 All participants received sibutramine for the following six months.…”

Disorders of appetite and eating

“…Hyperphagia and obesity are common sequelae of tumours of the hypothalamic region and their treatment with surgery and radiotherapy [11]. Damage to the ventromedial hypothalamus leads to hyperphagia, a low metabolic rate, growth hormone (GH) deficiency and autonomic imbalance that contribute to weight gain [11].…”

“…Damage to the ventromedial hypothalamus leads to hyperphagia, a low metabolic rate, growth hormone (GH) deficiency and autonomic imbalance that contribute to weight gain [11]. However, with the exception of GH replacement, few clinical trials have evaluated significant numbers of patients and their management by behavioural, dietary, pharma-cological and surgical approaches [11].…”