Successful treatment of hyperphagia by resection of a hypothalamic hamartoma

Infantile Hypothalamic Hamartoma: A Rare Presentation of Isolated Obesity

Hypothalamic hamartomas (HHs) are rare, benign brain tumors or lesions of the hypothalamus that are predominantly identified in cases of epilepsy and central precocious puberty (CPP), whereas isolated manifestations of infantile obesity are atypical. We herein report an 8-month-old boy with severe obesity (Kaup index 26.4 [>100th percentile]) and uncontrollable hyperphagia. His growth chart demonstrated remarkable weight gain that exceeded the length gain in magnitude. Brain magnetic resonance imaging identified a lesion consistent with HH. There were no episodes or clinical findings of epilepsy, CPP, or Cushing disease. Hypothalamic obesity should be considered in the diagnosis even in infants with excessive weight gain due to overeating.

Altered Food Behavior and Cancer: A Systematic Review of the Literature

There is evidence of an association between cancer and certain types of altered eating behaviors, including orthorexia, food cravings, and food addiction. Given the growing interest in the topic throughout the scientific community we conducted a systematic review to summarize current evidence on the development of altered food behavior, including food addiction and cancer. The Cochrane Collaboration and the Meta-analysis Of Observational Studies in Epidemiology guidelines were followed to perform this systematic review. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement was used to report the process and results. The structured literature search was conducted on 19 April 2022, on PubMed/Medline and Scopus, combining free-text terms and medical subject headings. A total of seven articles were included once the selection process was completed. Food craving has been associated with different types of cancer in adults and young patients, as well as with orthorexia; conversely, compulsive eating has only been explored in patients with prolactinoma treated with dopamine agonists. This systematic review explored a new area of research that warrants further investigation. More research is required to better understand the relationship between cancer and food behavior.

Is surgery effective for treating hypothalamic hamartoma causing isolated central precocious puberty? A systematic review

The aim of this review was to determine the role of surgery in treating hypothalamic hamartoma (HH) causing isolated central precocious puberty (CPP). Literature review was done according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Patients with isolated CPP due to HH, managed with surgical resection, were included. We found 33 studies, reporting 103 patients (76 pedunculated, 27 sessile). Patients were considered "cured" if the symptoms of PP had regressed and the hormone profile had normalized after surgery. Indications for surgery included hamartoma deemed surgically resectable (n-12), for the purpose of tissue diagnosis (n-3), partial response/failure of preoperative therapy (n-9), and unable to afford/to avoid long-term medical therapy (n-7). The extent of resection was total (TR) (n-39), near total/subtotal (NTR/STR) (n-20), partial (PR) (n-35), or unspecified (n-9). On follow-up (range: 3 months-16 years), 73.6% (56/76) of patients with pedunculated HH were cured, while 17.1% (13/76) had partial relief. Only 3/27 (11.1%) of patients with sessile HH were cured. All patients with a pedunculated hamartoma who underwent TR (n=36) improved, with 88.88% cured of the symptoms. Surgery had no effect in 17/23 (73.9%) patients with sessile HH who underwent PR. Psychological symptoms improved in 10/11 patients. There was no mortality. Permanent complications, in the form of 3rd nerve palsy, occurred in 3.7% (2/54) of the patients. To conclude, in the current era of availability of GnRH analogs, surgical resection in a subset of patients may be acceptable especially for small pedunculated hamartomas.