Melatonin Secretion and Increased Daytime Sleepiness in Childhood Craniopharyngioma Patients

Abstract

Craniopharyngioma is a rare dysontogenetic benign tumor. Patients frequently suffer from endocrine deficiencies, sleep disturbances, and obesity due to pituitary and hypothalamic lesions. A self-assessment daytime sleepiness questionnaire (German version of the Epworth Sleepiness Scale) was used to evaluate 79 patients with childhood craniopharyngioma. Because hypothalamic lesions may explain daytime sleepiness in craniopharyngioma patients, salivary melatonin and cortisol concentrations were examined in obese and nonobese craniopharyngioma patients (n = 79), patients with hypothalamic pilocytic astrocytoma (n = 19), and control subjects (n = 30). Using a general linear model procedure analyzing the influence of body mass index (BMI) and tumor diagnosis on diurnal salivary melatonin, we found that morning salivary melatonin levels were related to BMI (by F test, P = 0.004) and tumor diagnosis (by F test, P = 0.032). Also for nighttime salivary melatonin levels significant relations with BMI (by F test, P < 0.001) and tumor diagnosis (by F test, P = 0.025) were detectable. Melatonin concentrations in saliva of craniopharyngioma patients collected at night or in the morning showed a negative correlation (night: Spearman's rho = -0.42; P = 0.001; morning: Spearman's rho = -0.31; P = 0.020) with the patient's Epworth Sleepiness Scale score. Severely obese craniopharyngioma patients and severely obese hypothalamic tumor patients had similar patterns of melatonin secretion. Differences in terms of diurnal salivary cortisol concentrations were not detectable when patient groups and controls were compared. We speculate that hypothalamic lesions might be responsible for both obesity and daytime sleepiness. As decreased nocturnal melatonin levels were associated with increased daytime sleepiness, BMI, and hypothalamic tumor diagnosis, further studies on the beneficial effects of melatonin substitution on daytime sleepiness and weight control in these patients are warranted.

Obesity, metabolic syndrome, and insulin dynamics in children after craniopharyngioma surgery

“…This supports the hypothesis that physical activity might be decreased in these patients due to as yet unknown neuroendocrine disorders [26]. The prevalence of metabolic syndrome in childhood craniopharyngioma is not well known since there were only two reports that investigated this [34,37].…”

Childhood Craniopharyngioma

“…Based on self-assessment using nutritional diaries, caloric intake was similar in craniopharyngioma patients and BMI-matched controls [39]. Marked daytime sleepiness and disturbances of the day-night rhythm have been demonstrated in obese craniopharyngioma patients [40]. Daytime sleepiness and obesity in these patients were both correlated with low nocturnal melatonin levels; the proposed pathogenetic mechanism involves impaired hypothalamic regulation of melatonin rhythmicity in patients with suprasellar craniopharyngioma.…”

Analyses of Treatment Variables for Patients with Childhood Craniopharyngioma – Results of the Multicenter Prospective Trial KRANIOPHARYNGEOM 2000 after Three Years of Follow-Up

“…Overall, there are 0.5–2 new cases per million population occurring each year, 30–50% of which affect children and adolescents. Although the tumor itself is of low-grade histological malignancy and the overall 5-year survival rate of patients is high (91%), there is considerable morbidity even when the tumor is completely resected [1,2,3,4,5,6,7,8,9,10]. Long-term prognosis and quality of life in survivors are severely impaired due to consequential hormonal deficits that typically result in stunted growth and obesity [1,4,5,6,7,8,10].…”

“…Although the tumor itself is of low-grade histological malignancy and the overall 5-year survival rate of patients is high (91%), there is considerable morbidity even when the tumor is completely resected [1,2,3,4,5,6,7,8,9,10]. Long-term prognosis and quality of life in survivors are severely impaired due to consequential hormonal deficits that typically result in stunted growth and obesity [1,4,5,6,7,8,10]. In response to those cases of growth hormone (GH) deficiency, GH has been successfully used in the treatment of short stature in survivors of childhood craniopharyngioma [11,12,13,14,15,16,17].…”