Abstract
Patients with craniopharyngioma often have comorbidities, such as obesity and hypopituitarism. These two conditions affect each other and worsen the quality of life of patients, which lead to a higher risk of morbidity and mortality. In addition, abdominal obesity, measured as waist circumference (WC), is together with other parameters [arterial hypertension, hyperglycemia, hypertriglyceridemia, and reduced levels of high-density lipoprotein (HDL) cholesterol], one of the components of metabolic syndrome (MS). Each one of these morbidities occurs in patients with craniopharyngioma more frequently than in the remaining population. On these bases, we evaluated metabolic parameters in patients with craniopharyngioma at the time of diagnosis and after a 5-year follow-up, which compares these data with those of age-, gender-, WC-, and body mass index (BMI)-matched controls. In addition, we evaluated the prevalence of MS according to IDF criteria (MS-IDF) and the prevalence of MS according to ATP III (MS-ATPIII) criteria in patients and controls at baseline and after 5 years. We recruited 20 patients with craniopharyngioma (age 38.5 ± 15 years, 10 M) and 20 age-, gender-, WC- and BMI-matched controls (age 34.16 ± 13.19 years, 10 M). In all patients and controls, we evaluated the following: anthropometric features [height, weight, BMI, WC, hip circumference (HC) and waist-to-hip ratio (WHR)], systolic blood pressure (SBP) and diastolic blood pressure (DBP), lipid profile [total cholesterol (TC), HDL, low-density lipoprotein (LDL) cholesterol, triglycerides (TG)], and blood glucose at baseline and after 5 years. The prevalence of MS, according to IDF and ATPIII criteria, was calculated in the two groups at baseline and after 5 years. According to our results, at baseline, patients with craniopharyngioma had a worse metabolic profile than controls and a higher prevalence of MS. Besides, at a 5-year follow-up, patients still had impaired metabolic characteristics and more frequent MS (according to IDF and ATPIII criteria) when compared to controls. These data confirm that MS in patients with craniopharyngioma is unresponsive to life-changing interventions and to a common pharmacological approach. Other factors may be involved in the evolution of these conditions; so, further studies are needed to establish the correct management of these patients.
Highlights
Craniopharyngiomas represent 1–15% of all primary intracranial neoplasms [1–3] and 5.6–15% of intracranial tumors of children [2]
The hypothalamic obesity associated with this condition is believed to be due to an alteration of both the signals that reach the hypothalamus from the periphery, mainly mediated by leptin, an anorectic action protein that induces a reduction in the sense of hunger and an increase of energy expenditure, and the signal that goes from the hypothalamus to the periphery, with an increase in vagal tone, insulin secretion, and adipogenesis [13–15]
There was no statistical difference in the patient group and in the control group at baseline and after 5 years in body composition (Tables 3, 4) and between patients and controls for the same parameters at the two study time points (Table 5)
Summary
Craniopharyngiomas represent 1–15% of all primary intracranial neoplasms [1–3] and 5.6–15% of intracranial tumors of children [2]. It is the most common lesion involving the hypothalamic–pituitary area in children, about half of cases are diagnosed in adults [1, 3, 4], with a peak incidence around 65–74 years. The symptoms associated with the presence of craniopharyngiomas are due to the development of a space-occupying mass in a non-expandable region and are characterized by headache, visual changes, hydrocephalus, pituitary deficits, and hypothalamic disease (diabetes insipidus, obesity, dysphoria, numbness, temporal-spatial disorientation and alterations in the sense of hunger or thirst, sleep– wake rhythm, and thermoregulation) [5–12]. Abdominal obesity, measured as waist circumference (WC), is, with other parameters such as arterial hypertension, hyperglycemia, hypertriglyceridemia, and reduced high-density lipoprotein (HDL) cholesterol levels, one of the components of the metabolic syndrome (MS), the elements of which occur, in patients with craniopharyngioma, more frequently than in the remaining population [16, 17]
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