Postoperative and Long-Term Endocrinologic Complications of Craniopharyngioma

Abstract

<b><i>Background:</i></b> Craniopharyngioma (CP), despite being a malformational tumor of low histological grade, causes considerable morbidity and mortality mostly due to hypothalamo-pituitary dysfunction that is created by tumor itself or its treatment. <b><i>Summary:</i></b> Fluid-electrolyte disturbances which range from dehydration to fluid overload and from hypernatremia to hyponatremia are frequently encountered during the acute postoperative period and should be carefully managed to avoid permanent neurological sequelae. Hypopituitarism, increased cardiovascular risk, hypothalamic damage, hypothalamic obesity, visual and neurological deficits, and impaired bone health and cognitive function are the morbidities affecting the well-being of these patients in the long term. <b><i>Key Messages:</i></b> Timely and optimal treatment of early postoperative and long-term complications of CP is crucial for preserving quality of life of these patients.

Novel clinical algorithm for hypothalamic obesity in youth with brain tumours and factors associated with excess weight gain

“…This study is also unique due to inclusion of multiple hypothalamic and suprasellar tumours and masses, in addition to craniopharyngiomas and in its comparison of surgical vs. non‐surgical intervention. Craniopharyngiomas and single treatment modalities (e.g., radiation or total surgical resection) have been the focus of most prior studies 4,6,8,9,13,14,21 …”

“…Craniopharyngiomas and single treatment modalities (e.g., radiation or total surgical resection) have been the focus of most prior studies. 4,6,8,9,13,14,21 Factors showing significant association with development of overweight/obesity include elevated BMI at diagnosis, weight gain prior to diagnosis, surgical tumour resection independent of tumour type, central hypothyroidism and precocious puberty and reported hyperphagia. These findings further support previous data showing that overweight or obesity at diagnosis and/or weight gain prior to diagnosis is associated with increased risk for developing HO, [5][6][7][8]12 which reinforces the need for preventative primary care screening of BMI at least annually for all youth.…”

“…Previous reports estimate that HO affects 30–77% of individuals who have undergone craniopharyngioma treatment, 4 some of whom appear to be impacted prior to diagnosis 5–8 . Those who have a higher body mass index (BMI) before diagnosis and early and rapid weight gain are at greatest risk for severe obesity after neurosurgical intervention, 9–11 and a relationship has been observed between the development of obesity and greater hypothalamic involvement of the tumour 10,12–14 . Obesity onset has been reported as early as 3 months after diagnosis and treatment, and when it occurs, the onset is typically within 3 years 9,15 …”

“…[5][6][7][8] Those who have a higher body mass index (BMI) before diagnosis and early and rapid weight gain are at greatest risk for severe obesity after neurosurgical intervention, [9][10][11] and a relationship has been observed between the development of obesity and greater hypothalamic involvement of the tumour. 10,[12][13][14] Obesity onset has been reported as early as 3 months after diagnosis and treatment, and when it occurs, the onset is typically within 3 years. 9,15 Strategies to prevent rapid early weight gain in youth with hypothalamic tumours should ideally include early identification of those most at risk.…”

Endocrine Disorders in Children with Brain Tumors: At Diagnosis, after Surgery, Radiotherapy and Chemotherapy

“…Patients with pituitary or diencephalon surgery often develop alterations of water homeostasis with polyuria and electrolyte disturbances, such as hyper- or hyponatremia, which should be promptly identified in order to avoid neurological sequelae [ 29 , 30 , 31 , 32 , 33 , 34 ].…”