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Original article

Vol. 148 No. 0506 (2018)

A ten-year follow-up study of treatment outcome of craniopharyngiomas

  • Lukas Andereggen
  • Benjamin Hess
  • Robert H. Andres
  • Marwan El-Koussy
  • Luigi Mariani
  • Andreas Raabe
  • Rolf W. Seiler
  • Emanuel Christ
DOI
https://doi.org/10.4414/smw.2018.14521
Cite this as:
Swiss Med Wkly. 2018;148:w14521
Published
07.02.2018

Summary

PURPOSE

Craniopharyngioma-related hypothalamic obesity is a devastating complication with limited data on whether long-term follow-up should focus on problems other than endocrine deficiencies and weight gain. The primary endpoint was the assessment of predictors of hypothalamic obesity development; the secondary endpoint was the assessment of functional outcome (endocrine deficiencies, visual acuity) at long-term follow-up.

METHODS

This retrospective case-note study examined craniopharyngioma patients with at least 2 years of follow-up. Clinical, radiological and biochemical characteristics were assessed at diagnosis, postoperatively, and at last follow-up.

RESULTS

Thirty-two patients met the inclusion criteria. Median follow-up period was 9.8 years (range 2.2–33 years). Longitudinal changes in body mass index (BMI) were substantial (median ΔBMI/year was +0.48 kg/m2/year, interquartile range 0.28–1.33). The prevalence of patients with hypothalamic obesity had significantly increased at last follow-up (45 vs 4%; p = 0.003). Long-term pituitary deficiencies remained high. Diabetes insipidus was common (66% vs 34%, p<0.001), with postoperative diabetes insipidus but not hypothalamic involvement, being an independent predictor for hypothalamic obesity (odds ratio 15.2, 95% confidence interval 1.3–174.8, p = 0.03). Osteodensitometry in two thirds of patients at last follow-up revealed a pathological bone density in 53% of those tested.

CONCLUSIONS

Rates of hypothalamic obesity and long-term pituitary deficiencies are substantial, with postoperative diabetes insipidus being a potential marker for hypothalamic obesity development. Besides long-term monitoring of endocrine deficiencies with consideration of osteodensitometry, early weight control programmes and continuing multidisciplinary care are mandatory in craniopharyngioma patients.

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