MON-276 Post-Surgical Metabolic Outcomes in Adult-Onset Craniopharyngioma: A Single Pituitary Center Experience

Abstract

Background:Craniopharyngiomas, while benign, have the highest morbidity of all pituitary tumors. Hypothalamic obesity (HO), one of the most devastating consequences, is commonly studied in the pediatric population, but few data are available on weight and other metabolic outcomes in adult-onset craniopharyngiomas (AOCP).Methods:We conducted a retrospective chart review of 49 adult patients with AOCP who underwent surgery between 1/2014 and 5/2019 at an academic pituitary center. Weight, BMI, metabolic diseases (type 2 diabetes, hypertension, hyperlipidemia, cardiovascular disease, OSA), and pituitary hormone deficiencies were recorded pre-surgery and at last follow up and analyzed using paired t-tests or McNemar’s test.Results:Median age was 56 years (51% women), 45% had >1 surgery (range 1-5), and 49% had radiotherapy. Of 72 total surgeries, 54% were craniotomies and 68% of surgeries resulted in subtotal resections. Median follow up was 25 months. Median BMI was 29.2 and 30.5 kg/m2 at baseline and at last follow up, respectively. Weight was higher at last follow up (mean increase 2.7 kg; p=0.043), with an average of 4% weight gain. Patients with baseline normal and overweight BMI had significant weight gain (mean increase 5.1 kg, p=0.045; mean increase 5.5 kg, p=0.015 respectively), while those who were obese at baseline did not (mean increase 2.0 kg, p=0.302). The proportion of patients with obesity (BMI>30) increased from 37% to 53% (p=0.008). 31% of patients had >5% weight gain, with mean increase in BMI of 4.1 kg/m2 (p<0.0001) and mean weight gain of 13.1 kg (p<0.0001). 24.5% had an increase in the total number of metabolic diseases (p=0.07). Of 43 patients who were overweight or obese at last follow up, obesity was addressed in 51%, most commonly through lifestyle counseling (49%) and adjustment of hormone replacement in response to weight gain (23%). Two patients had bariatric surgery within one year of pituitary surgery. The proportion of patients with ≥3 hormone deficiencies increased from 18% to 55% (p=0.0003). At last follow-up, only one patient had GHD, diagnosed by low age-adjusted IGF-1 level. 14 of 15 patients with ≥3 hormone deficiencies had normal age-adjusted IGF-1 levels and one patient had normal GH provocative testing.Conclusion:Weight significantly increased after surgery for AOCP, with mean weight gain of 4%. 31% of patients had a marked increase in BMI and weight, suggesting possible HO. GHD is likely under-diagnosed in AOCP, and IGF-1 may not be a sensitive tool. Obesity-directed treatment is under-utilized in this patient population.