Longitudinal study on weight and height development before and after diagnosis of childhood craniopharyngioma

Abstract

We recently reported that patients with childhood craniopharyngioma who were at risk for severe obesity presented with higher body mass index (BMI) SDS already at the time of diagnosis. Accordingly, we hypothesized that pathogenic mechanisms might have influence on weight and growth development already before diagnosis. We analyzed whether childhood craniopharyngioma caused weight gain and short stature already during infancy and childhood before diagnosis. Auxiological data were evaluated based on patient's records (n=90) of a standardized prospective and longitudinal health care survey (Vorsorgeuntersuchungen U1-U9). Furthermore, hypothalamic involvement of craniopharyngioma and BMI and height SDS at the time of diagnosis, at yearly intervals (year 1 to 8) after diagnosis and at the latest visit during follow-up were evaluated. Relevant decreases in patients' height SDS started at an early age of 10–12 months and persisted until diagnosis of childhood craniopharyngioma. Relevant increases in BMI SDS were detectable during the period between four and six years of age. BMI SDS at yearly postoperative intervals (year 1–6) positively correlated with BMI SDS at the time of diagnosis (p<0.05). In linear regression analysis, hypothalamic involvement (p<0.001), BMI SDS at the age of four years (p<0.01) and height at birth (p<0.01) had relevant and independent impact on the development of obesity. Patients with hypothalamic involvement (n=48) presented with higher BMI SDS at U8 (3.5–4.0 years) (p<0.05), U9 (6 years) (p<0.01), at the time of diagnosis (p<0.001) as well as during yearly follow-up (p<0.05) when compared with patients without hypothalamic involvement (n=42). Already at early infant age (U6) growth rates were significantly reduced regardless of hypothalamic involvement. We conclude that reduced growth rates occurred early in history of patients with childhood craniopharyngioma. Increases in BMI SDS were detectable in late history and were predictive for further development of obesity. Hypothalamic tumor involvement was a major risk factor for obesity in patients with childhood craniopharyngioma leading to increased BMI SDS already at the time of diagnosis. (www.kraniopharyngeom.com)