1027 Title: Hypersomnolence following resection of a craniopharyngioma

Abstract

Abstract Introduction Craniopharyngiomas are rare tumors that arise from Rathke’s pouch remnants along the pituitary-hypothalamic axis. The tumor and its treatment can lead to significant neurological and endocrinological complications including alterations in appetite, endocrine insufficiency, circadian rhythms and sleep. We report the case of a woman who developed hypersomnia following resection of a craniopharyngioma Report of case(s) This 38-year-old female with neither significant past medical history of sleep, medical, neurological, or psychiatric disorders nor a family history of narcolepsy presented with galactorrhea and amenorrhea. Imaging showed a pituitary tumor. She underwent resection of the tumor with a tissue diagnosis of an adamantinomatous craniopharyngioma. MRI post procedure showed post-surgical changes without new lesions. Diabetes insipidus and panhypopituitarism developed for which appropriate replacement therapy was initiated. She gained approximately one hundred pounds in the weeks post-surgery. Her family described new onset snoring in supine sleeping position and witnessed apneas. She denied hypnagogic hallucinations, cataplexy, or sleep paralysis. She presented to the sleep medicine clinic a few months later for evaluation of persistent hypersomnolence. Conclusion The most common sleep disorders post craniopharyngioma resection are sleep-related breathing disorder, hypersomnia, and circadian rhythm disorder. Sleep and appetite are felt to be altered because of direct surgical compression, injury or vascular compromise of structures involved in the control of sleep, wakefulness, and appetite. This can produce hypothalamic dysfunction induced obesity with secondary sleep-related breathing disorder and worsening hypersomnolence. In this woman the temporal relationship between the surgery and the onset of symptoms is most suggestive of this hypothalamic injury, resulting in abnormal regulation of both appetite and sleep. Improvements in weight control and hypersomnia with use of stimulant therapy in the setting of secondary obstructive sleep apnea have been reported and in addition to standard positive airway pressure therapies give hope for the management of these complications of craniopharyngioma resection. Support (if any)