Perioperative Dexamethasone Treatment in Childhood Craniopharyngioma

Abstract

The substitution of dexamethasone during and after surgery of childhood craniopharyngioma is necessary in order to treat and/or prevent brain edema and adrenal insufficiency. Early post-operative weight gain is a predictor for severe obesity during long-term follow-up. In a retrospective analysis of 60 patients with childhood craniopharyngioma we inquired whether dose and duration of perioperative dexamethasone therapy (n = 68) had influence on short-term post-operative weight gain and long-term development of severe obesity. The median follow-up period was 4.2 years, ranging from 1 to 9 years. 24 patients (14 f/10 m) developed severe obesity (BMI > 3 SD). 28 patients (10 f/18 m) retained normal weight (BMI < 2 SD). Eight patients presented with a BMI between 2 and 3 SD at the final visit. Differences in terms of age at surgery or follow-up period were non-detectable between the analyzed groups of craniopharyngioma patients. Duration and cumulative dexamethasone doses (mg/m2 BSA) for perioperative dexamethasone therapy were similar for severely obese patients (duration: 8.7 d; 4.5 - 17 d, cumulative dose: 74; 42 - 177 mg/m2 BSA) and normal weight patients (duration: 10.0 d; 1 - 41 d; dose: 76; 9 - 390 mg/m2 BSA). Whereas cumulative dexamethasone doses positively (p < 0.01; rho: 0.424) correlated with weight gain during the first year following surgery, long-term development of severe obesity was not influenced by dose and duration of perioperative dexamethasone treatment. Patients who developed severe obesity during follow-up had a higher (p < 0.001) BMI already at the time of diagnosis. We conclude that dose and duration of perioperative dexamethasone treatment had short-term effects on post-operative weight gain, but not on the development of long-term severe obesity. The results of our retrospective analysis are currently tested in a prospective surveillance study Kraniopharyngeom 2000 (www.kraniopharyngeom.com).

Long Term Sequelae of Pediatric Craniopharyngioma ? Literature Review and 20 Years of Experience

“…Obesity develops early after treatment and weight gain was found to rapidly increase in the first 6–12 months after treatment (Muller et al, 2001; Ahmet et al, 2006); later on BMI stabilizes but obesity continues to remain a problem (Ahmet et al, 2006; Holmer et al, 2010). Following treatment, the prevalence of obesity is higher, reaching up to 55% (Hoffman et al, 1992; Muller et al, 2001, 2003b; Poretti et al, 2004; Srinivasan et al, 2004; Ahmet et al, 2006; Lek et al, 2010; O’gorman et al, 2010b; Elliott et al, 2011). Review of our patients indicates a lower prevalence of severe obesity associated with less aggressive surgery (Figure 2).…”

Childhood Craniopharyngioma

“…Obesity and eating disorders are observed in 40–50% of craniopharyngioma patients [5,32,33,34,35,36]. A disturbance of hypothalamic structures, particularly the ventromedial hypothalamus, by the tumor and its treatment is considered to be the major pathogenetic factor for hyperphagia and obesity.…”

Longitudinal Changes in Body Mass Index in Children with Craniopharyngioma

“…However, the follow-up period was limited to 1 year and the authors were looking at the postoperative risk factors associated with obesity and not the obese status at presentation in particular. Another study by Müller et al [23] also found a significant association of higher postoperative BMI with preoperative BMI status of patients. Furthermore, a study by Sorva [24] observed an increase in the percentage of obese patients from 27% preoperatively to 58% after 5 years.…”