Long-term follow-up of children with craniopharyngioma

Stahnke, N; Grübel, G.; Lagenstein, I; Willig, R. P.

doi:10.1007/bf00442445

Cited by 92 publications

(60 citation statements)

References 59 publications

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“…In contrast to the high incidence of anterior pituitary dysfunction, evidence of diabetes insipidus has been observed in only a minority of the patients prior to surgery (fig. 3b) [23, 37,39,40,41,42,43]. Following surgical treatment of a craniopharyngioma, virtually every child and adolescent will be left with some degree of hypothalamic-pituitary dysfunction [23, 38].…”

Section: Resultsmentioning

confidence: 99%

Craniopharyngiomas in Children

2007

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Background: The modern era of pediatric craniopharyngioma treatment includes multiple modalities including microsurgical resection, irradiation, brachytherapy or chemotherapy. No clear consensus as to the best therapeutic approach has yet been established. The aim of this study was to describe the techniques and strategies for the treatment of pediatric craniopharyngiomas in light of a literature review with particular attention to the incidence of adverse postoperative effects. Methods: Twenty-seven pediatric patients (median age 9.0 years) who were surgically treated for craniopharyngiomas were evaluated. We reviewed the recent literature for clinical features of craniopharyngiomas in children, including the present cases. Results: The overall rate of radiographically complete resection of our cases was 92.6%. In the literature we reviewed, the rate of gross total resection was 33–91% (average 57.8%). According to the literature, recurrence rates range from zero to 52.8% (average 16.1%) in the gross total resection group, 51.1% in the subtotal resection without radiation therapy group, and 33.5% in the subtotal resection with radiation therapy group. In six of our most recent cases, for whom we have complete outcome analysis, radiographically complete resection is 100% with only one recurrence so far over 4 years. Conclusions: For patients in whom early postoperative MRI reveals complete craniopharyngioma removal, a very low rate of recurrence is anticipated. In the authors’ experience, radiographically total excision of even large craniopharyngiomas can be safely achieved by one or a combination of several advanced microsurgical techniques, sometimes by a staged strategy. Major morbidities can be avoided, although moderate morbidities occur and require management.

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Section: Resultsmentioning

confidence: 99%

Craniopharyngiomas in Children

2007

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“…Earlier studies of HO have usually been retrospective, or used longitudinal data and without appropriate control groups (4,(28)(29)(30)(31)(32). We have compared children with HO with CH and SO to control for hormonal deficiencies and the effects of adipose tissue on insulin and adipocytokine secretion.…”

Section: Discussionmentioning

confidence: 99%

Hyperleptinaemia rather than fasting hyperinsulinaemia is associated with obesity following hypothalamic damage in children

Shaikh¹,

Grundy

Kirk³

2008

European Journal of Endocrinology

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Background: Obesity following hypothalamic damage is often severe and resistant to lifestyle changes. Disruption of hypothalamic feedback mechanisms that maintain energy homeostasis may be responsible for this intractable obesity. Adipocytokines including insulin and leptin are also known to be important regulators of appetite and weight. Objective: To investigate the role of insulin, leptin, adiponectin and resistin in the aetiology of hypothalamic obesity (HO). Design: This was a cross-sectional study of three groups of children, those with HO, congenital hypopituitarism (CH) and simple obesity (SO). Results: A total of 69 children (HOZ28, CHZ18, SOZ23) had leptin, resistin, adiponectin and insulin measured. Although fasting hyperinsulinaemia and insulin resistance were demonstrated, no differences in insulin or insulin resistance were seen between the groups. The HO group, however, had higher levels of leptin, adiponectin and resistin, which persisted even after adjusting for fat mass, compared with the other groups (P!0.05). Conclusion: No differences in fasting hyperinsulinaemia or insulin resistance were seen between the groups; however, leptin levels are elevated, even after adjusting for fat mass, suggesting that an element of leptin resistance is associated with HO. This is consistent with the inability of leptin to act on the hypothalamus, either due to transport across the blood-brain barrier or dysfunctional receptors. The lack of response to leptin may be more important in the development of obesity in these individuals, and the fasting hyperinsulinaemia is a result of the increased adipose tissue rather than the cause of the weight gain.

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“…Patients with brain tumours such as craniopharyngiomas, which involve the hypothalamic region, are at high risk for the development of obesity (1,2,3,4,5,6,7,8). Hypothalamic obesity appears to result from tumouror treatment-related damage of hypothalamic nuclei especially in the ventromedial region that causes impairment of mechanisms controlling satiety, hunger and energy expenditure (9,10,11,12).…”

Section: Introductionmentioning

confidence: 99%

GLP-1 analogues as a new treatment option for hypothalamic obesity in adults: report of nine cases

Zoicas

Droste

Mayr

et al. 2013

European Journal of Endocrinology

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Background: Patients with hypothalamic pathology often develop morbid obesity, causing severe metabolic alterations resulting in increased morbidity and mortality. Glucagon-like peptide-1 (GLP-1) analogues improve glycaemic control in type 2 diabetic patients and cause weight loss in obese patients by yet unknown mechanisms. Here we tested whether GLP-1 analogues were also effective in the treatment of obesity and associated metabolic alterations in patients with hypothalamic disease. Methods: Nine patients (eight with type 2 diabetes mellitus) with moderate to severe hypothalamic obesity were treated with GLP-1 analogues for up to 51 months. Body weight, homeostasis model assessment -insulin resistance (HOMA-IR), HbA1c and lipids were assessed. Results: Eight patients experienced substantial weight loss (K13.1G5.1 kg (range K9 to K22)). Insulin resistance (HOMA-IR K3.2G3.5 (range K9.1 to 0.8)) and HbA1c values (K1.3G1.4% (range K4.5 to 0.0)) improved under treatment (24.3G18.9 months (range 6 to 51)). Five patients reported increased satiation in response to the treatment. Two of the eight patients complained about nausea and vomiting and one of them abandoned therapy because of sustained gastrointestinal discomfort after 6 months. One patient suffered from intolerable nausea and vomiting and discontinued treatment within 2 weeks. Conclusion: GLP-1 analogues can cause substantial and sustained weight loss in obese patients with hypothalamic disease. This offers a new approach for medical treatment of moderate to severe hypothalamic obesity and associated metabolic alterations.

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Long-term follow-up of children with craniopharyngioma

Cited by 92 publications

References 59 publications

Craniopharyngiomas in Children

Craniopharyngiomas in Children

Hyperleptinaemia rather than fasting hyperinsulinaemia is associated with obesity following hypothalamic damage in children

GLP-1 analogues as a new treatment option for hypothalamic obesity in adults: report of nine cases

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