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
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
