Context: Craniopharyngioma is a sellar tumor associated with high rates of pituitary deficiencies (similar to 98%) and hypothalamic obesity (similar to 50%).Objective: This work aims to determine... Show moreContext: Craniopharyngioma is a sellar tumor associated with high rates of pituitary deficiencies (similar to 98%) and hypothalamic obesity (similar to 50%).Objective: This work aims to determine the efficacy regarding long-term weight loss after bariatric surgery in obese craniopharyngioma patients with hypothalamic dysfunction.Methods: This retrospective, case-control, multicenter, international study included obese craniopharyngioma patients (N=16; of whom 12 are women) with a history of bariatric surgery (12 Roux-en-Y gastric bypass, 4 sleeve gastrectomy; median age 21 years [range, 15-52 years], median follow-up 5.2 years [range, 2.0-11.3 years]) and age/sex/surgery/body mass index-matched obese controls (N=155). Weight loss and obesity-related comorbidities up to 5 years after bariatric surgery were compared and changes in hormonal replacement therapy evaluated.Results: Mean weight loss at 5-year follow-up was 22.0% (95% CI, 16.1%-27.8%) in patients vs 29.5% (95% CI, 28.0%-30.9%) in controls (P=.02), which was less after Roux-en-Y gastric bypass (22.7% [16.9%-28.5%] vs 32.0% [30.4%-33.6%]; P=.003) but at a similar level after sleeve gastrectomy (21.7% [-1.8% to 45.2%] vs 21.8% [18.2%-25.5%]; P=.96). No major changes in endocrine replacement therapy were observed after surgery. One patient died (unknown cause). One patient had long-term absorptive problems.Conclusion: Obese patients with craniopharyngioma had a substantial mean weight loss of 22% at 5-year follow-up after bariatric surgery, independent of type of bariatric surgery procedure. Weight loss was lower than in obese controls after Roux-en-Y gastric bypass. Bariatric surgery appears to be effective and relatively safe in the treatment of obese craniopharyngioma patients. Show less
Pluimakers, V.G.; Santen, S.S. van; Fiocco, M.; Bakker, M.C.E.; Lelij, A.J. van der; Heuvel-eibrink, M.M. van den; Neggers, S.J.C.M.M. 2021
Childhood cancer survivors (CCS) are at increased risk to develop metabolic syndrome (MetS), diabetes, and cardiovascular disease. Common criteria underestimate adiposity and possibly underdiagnose... Show moreChildhood cancer survivors (CCS) are at increased risk to develop metabolic syndrome (MetS), diabetes, and cardiovascular disease. Common criteria underestimate adiposity and possibly underdiagnose MetS, particularly after abdominal radiotherapy. A systematic literature review and meta-analysis on the diagnostic and predictive value of nine newer MetS related biomarkers (adiponectin, leptin, uric acid, hsCRP, TNF-alpha, IL-1, IL-6, apolipoprotein B (apoB), and lipoprotein(a) [lp(a)]) in survivors and adult non-cancer survivors was performed by searching PubMed and Embase. Evidence was summarized with GRADE after risk of bias evaluation (QUADAS-2/QUIPS). Eligible studies on promising biomarkers were pooled. We identified 175 general population and five CCS studies. In the general population, valuable predictive biomarkers are uric acid, adiponectin, hsCRP and apoB (high level of evidence), and leptin (moderate level of evidence). Valuable diagnostic biomarkers are hsCRP, adiponectin, uric acid, and leptin (low, low, moderate, and high level of evidence, respectively). Meta-analysis showed OR for hyperuricemia of 2.94 (age-/sex-adjusted), OR per unit uric acid increase of 1.086 (unadjusted), and AUC for hsCRP of 0.71 (unadjusted). Uric acid, adiponectin, hsCRP, leptin, and apoB can be alternative biomarkers in the screening setting for MetS in survivors, to enhance early identification of those at high risk of subsequent complications. Show less
Santen, S.S. van; Olsson, D.S.; Hammarstrand, C.; Wijnen, M.; Fiocco, M.; Heuvel-Eibrink, M.M. van den; ... ; Neggers, S.J.C.M.M. 2020
Context: Patients with craniopharyngioma suffer from obesity and impaired bone health. Little is known about longitudinal changes in body composition and bone mineral density (BMD).Objective: To... Show moreContext: Patients with craniopharyngioma suffer from obesity and impaired bone health. Little is known about longitudinal changes in body composition and bone mineral density (BMD).Objective: To describe body composition and BMD (change).Design: Retrospective longitudinal study.Setting: Two Dutch/Swedish referral centers.Patients: Patients with craniopharyngioma (n = 112) with a dual X-ray absorptiometry (DXA) scan available (2 DXA scans, n = 86; median time 10.0 years; range 0.4-23.3) at age >= 18 years (58 [52%1 male, 50 [45%] childhood onset).Main outcome measures: Longitudinal changes of body composition and BMD, and associated factors of Delta Z-score (sex and age standardized).Results: BMI (from 28.8 +/- 4.9 to 31.2 +/- 5.1 kg/m(2), P< .001), fat mass index (FMI) (from 10.5 +/- 3.6 to 11.9 +/- 3.8 kg/m(2), P= .001), and fat free mass index (FFMI) (from 18.3 +/- 3.2 to 19.1 +/- 3.2 kg/m(2) , P< .001) were high at baseline and increased. Fat percentage and Z-scores of body composition did not increase, except for FFMI Z-scores (from 0.26 +/- 1.62 to 1.06 +/- 2.22, P< .001). Z-scores of total body, L2-L4, femur neck increased (mean difference 0.61 +/- 1.12, P< .001; 0.74 +/- 1.73, P< .001; 0.51 +/- 1.85, P= .02). Linear regression models for AZ-score were positively associated with growth hormone replacement therapy (GHRT) (femur neck: beta 1.45 [95% CI 0.51-2.39]); and negatively with radiotherapy (femur neck: beta -0.79 [-1.49 to -0.09]), glucocorticoid dose (total body: beta -0.06 (-0.09 to -0.02]), and medication to improve BMD (L2-L4: beta -1.06 [-1.84 to -0.28]).Conclusions: Z-scores of BMI, fat percentage, and FMI remained stable in patients with craniopharyngioma over time, while Z-scores of FFMI and BMD increased. Higher glucocorticoid dose and radiotherapy were associated with BMD loss and GHRT with increase. Show less
