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Influence of tumor location on the presentation and
evolution of craniopharyngiomas
Meuric
S, Brauner
R, Trivin
C, Souberbielle
JC, Zerah
M, Sainte-Rose
C
Universite Paris V, France.
Object. This study was performed to optimize the management of
craniopharyngiomas, particularly by identifying factors predicting weight
changes to prevent obesity.
Methods. A series of 35 patients who had
undergone surgery at a mean age of 7.4 +/- 3.7 years (standard deviation
[SD]) and had been followed up until 14.9 +/- 5 years of age by the same
endocrinologist were assigned to one of three groups according to their
hypothalamic involvement: Group 1 (10 patients) had no involvement, Group 2
(eight patients) had compression without involvement, and Group 3 (17
patients) had severe involvement.
Abnormal height and/or weight evolution
indicated the craniopharyngioma in only 17% of the patients, although these
elements were present at diagnosis in 85%.
Before surgery, 85% of the
patients lacked growth hormone, 24% lacked thyroid-stimulating hormone, 15%
lacked adrenocorticotropin hormone, and 12% lacked antidiuretic hormone.
All
had complete hypothalamic-pituitary deficiencies after surgery.
The body
mass index (BMI) before surgery (mean SD 1.1 +/- 1.6) was positively
correlated with BMI 1 year after surgery (mean SD 3.1 +/- 2), which
correlated with the BMI at the last evaluation (mean SD 3.1 +/- 1.9; p <
0.0001 for both).
Before surgery, patients in Group 3 had a greater BMI than
did Group 1 (p < 0.02).
The BMI of Group 1 patients did not change, but
those of Groups 2 and 3 patients increased during the 1st year after surgery
(p < 0.02 and p = 0.0003, respectively), with no further change.
The
changes occurred mainly during the first 3 months after surgery in Group 1,
during the first 6 months in Group 2, and throughout the year in Group 3.
Conclusions. The degree of hypothalamic involvement by the craniopharyngioma
determines the presentation and predicts weight changes after surgery.
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