Hypothalamic obesity: prevalence, associations and longitudinal trends in weight in a specialist adult neuroendocrine clinic

Steele, Caroline; Cuthbertson, Daniel J.; MacFarlane, I. A.; Javadpour, Mohsen; Das, Kumar; Gilkes, Catherine; Wilding, John; Daousi, Christina

doi:10.1530/eje-12-0792

Cited by 23 publications

(10 citation statements)

References 39 publications

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“…However, multivariable logistic regression adjusting for cofounders was not performed in these two studies; thus, it is hard to draw any conclusion in the relationship between image-based hypothalamic involvement and HO from these studies. On the contrary, several studies (27,28,38) failed to detect any correlation between neuroimaging features and postoperative weight gain or obesity, consistent with our findings. One possible explanation for this was that the MRI grading systems used in the above studies to assess hypothalamus involvement might be misleading and could not reflect the true status of hypothalamus.…”

Section: Discussionsupporting

confidence: 92%

Risk Factors for Hypothalamic Obesity in Patients With Adult-Onset Craniopharyngioma: A Consecutive Series of 120 Cases

Sun

Zhang

et al. 2021

Front. Endocrinol.

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ContextHypothalamic obesity (HO) is a severe complication following craniopharyngioma, but studies regarding the sequelae in adult-onset patients with craniopharyngioma are sparse.ObjectiveThe objective of the study was to describe weight changes after surgical treatment in adult-onset craniopharyngioma patients and to analyze risk factors for postoperative weight gain and HO.Subjects and MethodA retrospective analysis was conducted of 120 adult-onset patients who underwent surgery for craniopharyngioma and follow-up at the institution of the authors between January 2018 and September 2020. Clinical characteristics, anthropometric data, image features, treatment modalities, and endocrine indices were collected. Multivariable logistic regression analysis was used to identify independent risk factors for postoperative weight gain and HO.ResultsForty-nine (40.8%) patients had clinically meaningful weight gain (≥5%) in a median follow-up time of 12.0 months (range 1.0–41.0 months) after surgery. The mean postoperative weight gain in this subgroup was 17.59 ± 12.28 (%). Weight gain continued in the first year following surgery. Patients with lower preoperative BMI [OR 0.78, 95% CI (0.67–0.90), P = 0.001] and the adamantinomatous subtype [OR 3.46, 95% CI (1.02–11.76), P = 0.047] were more likely to experience postoperative weight gain ≥5%. The prevalence of HO was 19.2% preoperatively and increased to 29.2% at last follow-up postoperatively. Only preoperative BMI [OR 2.51, 95% CI (1.64–3.85), P < 0.001] was identified as an independent risk factor for postoperative HO.ConclusionsHO is a common complication in patients with adult-onset craniopharyngioma. Patients with higher preoperative BMI had a greater risk for developing HO postoperatively.

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Section: Discussionsupporting

confidence: 92%

Risk Factors for Hypothalamic Obesity in Patients With Adult-Onset Craniopharyngioma: A Consecutive Series of 120 Cases

Sun

Zhang

et al. 2021

Front. Endocrinol.

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“…Due to disturbances in satiety regulation, central sympathetic output, and energy expenditure, CP patients often develop morbid HO that is mostly nonresponsive to conventional lifestyle modifications (diet and exercise) [55][56][57][58][59] (Table 1). Only 1 case report observed a clinical significant effect of a dietary intervention by a protein-sparing modified fasting program (PSMF) [60]; however, once it had been discontinued, weight gain occurred.…”

Section: Lifestyle and Dietary Interventionsmentioning

confidence: 99%

The Diagnosis and Treatment of Craniopharyngioma

Müller

2019

Neuroendocrinology

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Craniopharyngioma (CP) is a rare embryonic malformation of the sellar/parasellar region with a low histological grade. Clinical manifestations are related to hypothalamic/pituitary deficiencies, visual impairment, and increased intracranial pressure. Recent insight into the molecular pathogenesis of CP opens new perspectives on targeted therapy in papillary CP harboring BRAF-V600E mutations. Further research to elucidate pathogenic mechanisms and hopefully prevent hypothalamic involvement of CP is warranted. If the tumor is favorably localized, the therapy of choice is complete resection, with care taken to preserve the optical and hypothalamic functions. In patients with unfavorable tumor localization (i.e., hypothalamic involvement), the recommended therapy is a limited hypothalamus-sparing surgical strategy followed by local irradiation. Surgical treatment strategies should be based on a multidisciplinary approach involving experienced teams. Centralizing the treatment of CP in experienced "centers of excellence" and multicenter-based networks for reference assessments should be considered to assure a high standard of treatment quality. CP recurrence and progression are frequent. Irradiation has proven effective in reducing recurrences and progression. Proton beam therapy, available in a wider range in the near future, will help to avoid radiooncological side effects. Anatomical involvement and/or surgical lesions of posterior hypothalamic areas can result in serious sequelae that compromise quality of life (QoL), such as hypothalamic obesity and psychopathological symptoms. Novel insights into neuropsychological sequelae after CP occurrence should be the basis for the development of therapeutic neuropsychological interventions. CP should be managed as a frequently chronic disease, providing ongoing care of pediatric and adult patients' clinical and QoL consequences by experienced multidisciplinary teams.

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“…The reaction of the hypothalamus to these signals is characterised by changing activity of two opposite circuits -stimulation or inhibition of food intake. The hypothalamic circuits of hunger/appetite and satiety create two pathways -anorexigenic and orexigenic -which are responsible for food intake and energy expenditure ( Figure 1) [12].…”

Section: Regulation Of Food Intake By Hypothalamo-gastrointestinal Axismentioning

confidence: 99%

Endokrynne implikacje otyłości i zabiegów bariatrycznych

Dyaczyński

Scanes

Koziec

et al. 2018

Endokrynologia Polska

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Obesity is a highly prevalent disease in the world associated with the disorders of endocrine system. Recently, it may be concluded that the only effective treatment of obesity remains bariatric surgery. The aim of the review was to compare the concepts of appetite hormonal regulation, reasons of obesity development and bariatric procedures published over the last decade. The reviewed publications had been chosen on the base on: 1. reasons and endocrine consequences of obesity; 2. development of surgery methods from the first bariatric to present and future less aggressive procedures; 3. impact of surgery on the endocrine status of patient. The most serious endocrine disturbances during obesity are dysfunctions of hypothalamic circuits responsible for appetite regulation, insulin resistance, changes in hormones activity and abnormal activity of adipocytes hormones. The currently recommended bariatric surgeries are Roux-en-Y gastric bypass, sleeve gastrectomy and adjustable gastric banding. Bariatric surgical procedures, particularly combination of restrictive and malabsorptive, decrease the body weight and eliminate several but not all components of metabolic syndrome. Conclusions: 1. Hunger and satiety are mediated by an interplay of nervous and endocrine signals. 2. Healthy adipose tissue secretion of adipokines is coordinated in an anti-inflammatory, insulin-sensitizing and cardioprotective pattern. However, with increasing fat mass this secretion pattern is changed into a proinflammatory, insulin resistant, atherogenic and fatal systemic environment. 3. Bariatric surgery is not a solution of the obesity problem for everyone. 4. Long term postsurgical observations of the hormonal profile changes are necessary and should be obligatory.

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Hypothalamic obesity: prevalence, associations and longitudinal trends in weight in a specialist adult neuroendocrine clinic

Cited by 23 publications

References 39 publications

Risk Factors for Hypothalamic Obesity in Patients With Adult-Onset Craniopharyngioma: A Consecutive Series of 120 Cases

Risk Factors for Hypothalamic Obesity in Patients With Adult-Onset Craniopharyngioma: A Consecutive Series of 120 Cases

The Diagnosis and Treatment of Craniopharyngioma

Endokrynne implikacje otyłości i zabiegów bariatrycznych

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