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Tao X, Fan X, Gui S, Liu J, Yang X, Li K, Yang J, Li C, Qiao H. Efficacy of intraoperative visual evoked potential amplitude reduction in predicting visual outcome after extended endoscopic endonasal resection of craniopharyngiomas. J Neurosurg 2024; 140:1270-1275. [PMID: 37948695 DOI: 10.3171/2023.9.jns23457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Accepted: 09/06/2023] [Indexed: 11/12/2023]
Abstract
OBJECTIVE Postoperative visual outcome is a major concern of neurosurgeons for patients with craniopharyngiomas. The current study aimed to investigate the value of visual evoked potential (VEP) amplitude reduction (N75-P100 and P100-N145) for predicting postoperative visual dysfunction (POVD) and refining current warning criteria for VEP monitoring. METHODS Data from 96 patients who underwent the extended endoscopic endonasal approach for craniopharyngiomas between October 2020 and November 2021 were retrospectively reviewed. VEP amplitude reduction ratios were calculated and compared between patients with POVD and those without. Subsequently, the critical threshold values of VEP amplitude reduction ratios for predicting POVD were obtained through receiver operating characteristic curve analysis. Finally, multivariate binary logistic regression analysis was applied to evaluate the effect of potential factors on the probability of experiencing POVD. RESULTS Both N75-P100 and P100-N145 amplitude reduction ratios were significantly higher in patients with POVD (p < 0.001 for both). The threshold value of the N75-P100 amplitude reduction ratio for predicting POVD was 51.76% with an area under the curve (AUC) of 0.816 (p < 0.001), while the threshold value of the P100-N145 amplitude reduction ratio was 38.80% with an AUC of 0.738 (p < 0.001). Both N75-P100 and P100-N145 amplitude reduction ratios were identified as independent predictors for POVD via multivariate analysis (p < 0.001 and p = 0.018, respectively). CONCLUSIONS Both N75-P100 and P100-N145 amplitude reduction ratios showed great potential to be indicators for POVD in patients with craniopharyngiomas. Regarding warning criteria for VEP monitoring, the authors recommend that both N75-P100 and P100-N145 amplitude reduction should be considered, with early warning criteria of a 50% reduction for N75-P100 amplitude and/or a 40% reduction for P100-N145 amplitude.
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Affiliation(s)
- Xiaorong Tao
- 1Department of Neurophysiology, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China; and
| | - Xing Fan
- 1Department of Neurophysiology, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China; and
| | - Songbai Gui
- 2Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Jiajia Liu
- 1Department of Neurophysiology, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China; and
| | - Xiaocui Yang
- 1Department of Neurophysiology, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China; and
| | - Ke Li
- 1Department of Neurophysiology, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China; and
| | - Jun Yang
- 1Department of Neurophysiology, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China; and
| | - Chuzhong Li
- 2Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Hui Qiao
- 1Department of Neurophysiology, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China; and
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Auer MK, Gebert D, Biedermann SV, Bindila L, Stalla G, Reisch N, Kopczak A, Fuss J. Altered endocannabinoid-dynamics in craniopharyngioma patients and their association with HPA-axis disturbances. Eur J Endocrinol 2021; 185:231-239. [PMID: 34061772 DOI: 10.1530/eje-21-0178] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 06/01/2021] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Patients with craniopharyngioma (CP) frequently suffer from morbid obesity. Endocannabinoids (ECs) are involved in weight gain and rewarding behavior but have not been investigated in this context. DESIGN Cross-sectional single-center study. METHODS Eighteen patients with CP and 16 age- and sex-matched controls were included. Differences in endocannabinoids (2-arachidonoylglycerol (2-AG) and N-arachidonoylethanolamine (AEA)) and endocannabinoid-like molecules (oleoyl ethanolamide (OEA), palmitoylethanolamide (PEA), and arachidonic acid (AA) were measured at baseline and following endurance exercise. We further explored ECs-dynamics in relation to markers of HPA-axis activity (ACTH, cortisol, copeptin) and hypothalamic damage. RESULTS Under resting conditions, independent of differences in BMI, 2-AG levels were more than twice as high in CP patients compared to controls. In contrast, 2-AG and OEA level increased in response to exercise in controls but not in CP patients, while AEA levels decreased in controls. As expected, exercise increased ACTH and copeptin levels in controls only. In a mixed model analysis across time and group, HPA measures did not provide additional information for explaining differences in 2-AG levels. However, AEA levels were negatively influenced by ACTH and copeptin levels, while OEA levels were negatively predicted by copeptin levels only. There were no significant differences in endocannabinoids depending on hypothalamic involvement. CONCLUSION Patients with CP show signs of a dysregulated endocannabinoid system under resting conditions as well as following exercise in comparison to healthy controls. Increased 2-AG levels under resting conditions and the missing response to physical activity could contribute to the metabolic phenotype of CP patients.
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Affiliation(s)
- Matthias K Auer
- Medizinische Klinik and Poliklinik IV, Klinikum der Universität München, LMU München, Munich, Germany
| | - Dorothea Gebert
- Research Group Clinical Neuroendocrinology, Max Planck Institute of Psychiatry, Munich, Germany
| | - Sarah V Biedermann
- Department of Psychiatry and Psychotherapy, Center for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Human Behavior Laboratory, Institute for Sex Research and Forensic Psychiatry, University Medical Center Hamburg-Eppendorf, Germany
| | - Laura Bindila
- Institute of Physiological Chemistry, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Günter Stalla
- Medizinische Klinik and Poliklinik IV, Klinikum der Universität München, LMU München, Munich, Germany
- Medicover Neuroendocrinology, Munich, Germany
| | - Nicole Reisch
- Medizinische Klinik and Poliklinik IV, Klinikum der Universität München, LMU München, Munich, Germany
| | - Anna Kopczak
- Institute for Stroke and Dementia Research, University Hospital, LMU Munich, Munich, Germany
| | - Johannes Fuss
- Human Behavior Laboratory, Institute for Sex Research and Forensic Psychiatry, University Medical Center Hamburg-Eppendorf, Germany
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Jung HW, Kim HY, Kim JY, Cheon JE, Kim IO, Kim SK, Shin CH, Yang SW, Lee YA. Cardiac autonomic dysfunction is associated with hypothalamic damage in patients with childhood-onset craniopharyngioma. PLoS One 2021; 16:e0246789. [PMID: 33591998 PMCID: PMC7886170 DOI: 10.1371/journal.pone.0246789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Accepted: 01/26/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Autonomic nervous system dysfunction is implicated in the development of hypothalamic obesity. We investigated the relationship between hypothalamic involvement (HI), central obesity, and cardiac autonomic dysfunction by assessing heart rate variability (HRV) indices in patients with childhood-onset craniopharyngioma. METHODS A cross-sectional study of 48 patients (28 males, 10-30 years old) with hypothalamic damage after childhood-onset craniopharyngioma was performed. Postoperative HI was graded as mild (n = 19) or extensive (n = 29) on magnetic resonance imaging. Anthropometry, body composition and HRV indices including the standard deviation of all normal R-R intervals (SDNN) and total power (TP) as overall variability markers, root-mean square differences of successive R-R intervals (RMSSD) and high frequency (HF) as parasympathetic modulation markers, and low frequency (LF) as a sympathetic/sympathovagal modulation marker were measured. RESULTS Patients with extensive HI had increased means of body mass index, waist circumference, and fat mass than those with mild HI (P < 0.05, for all). Centrally obese patients had a lower mean HF, a parasympathetic modulation marker, than centrally non-obese patients (P < 0.05). The extensive HI group had lower means of overall variability (SDNN and TP), parasympathetic modulation (HF), and sympathetic/sympathovagal modulation (LF) than the mild HI group (P < 0.05, for all). The interaction effect of HI and central obesity on HRV indices was not significant. In models adjusted for age, sex, and family history of cardiometabolic disease, the means of the overall variability indices (P < 0.05 for both SDNN and TP) and a sympathetic/sympathovagal modulation index (P < 0.05 for LF) were lower with extensive HI, without differences according to central obesity. CONCLUSIONS The reduced HRV indices with extensive HI suggests that hypothalamic damage may contribute to cardiac autonomic dysfunction, underscoring the importance of minimizing hypothalamic damage in patients with childhood-onset craniopharyngioma.
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Affiliation(s)
- Hae Woon Jung
- Department of Pediatrics, Kyung Hee University Medical Center, Seoul, Republic of Korea
| | - Hwa Young Kim
- Department of Pediatrics, Seoul National University Children’s Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Ji Young Kim
- Department of Pediatrics, Seoul National University Children’s Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jung-Eun Cheon
- Department of Radiology, Seoul National University Children’s Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - In-One Kim
- Department of Radiology, Seoul National University Children’s Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Seung-Ki Kim
- Department of Neurosurgery, Seoul National University Children’s Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Choong Ho Shin
- Department of Pediatrics, Seoul National University Children’s Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Sei Won Yang
- Department of Pediatrics, Seoul National University Children’s Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Young Ah Lee
- Department of Pediatrics, Seoul National University Children’s Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
- * E-mail:
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Peng J, Boekhoff S, Eveslage M, Bison B, Sowithayasakul P, Friedrich C, Müller HL. Nuchal Skinfold Thickness in Pediatric Brain Tumor Patients. Front Endocrinol (Lausanne) 2021; 12:772856. [PMID: 34975750 PMCID: PMC8716728 DOI: 10.3389/fendo.2021.772856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2021] [Accepted: 11/26/2021] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Severe obesity and tumor relapse/progression have impact on long-term prognosis in pediatric brain tumor patients. METHODS In a cross-sectional study, we analyzed nuchal skinfold thickness (NST) on magnetic-resonance imaging (MRI) follow-up monitoring as a parameter for assessment of nuchal adipose tissue in 177 brain tumor patients (40 World Health Organization (WHO) grade 1-2 brain tumor; 31 grade 3-4 brain tumor; 106 craniopharyngioma), and 53 healthy controls. Furthermore, body mass index (BMI), waist-to-height ratio, caliper-measured skinfold thickness, and blood pressure were analyzed for association with NST. RESULTS Craniopharyngioma patients showed higher NST, BMI, waist-to-height ratio, and caliper-measured skinfold thickness when compared to other brain tumors and healthy controls. WHO grade 1-2 brain tumor patients were observed with higher BMI, waist circumference and triceps caliper-measured skinfold thickness when compared to WHO grade 3-4 brain tumor patients. NST correlated with BMI, waist-to-height ratio, and caliper-measured skinfold thickness. NST, BMI and waist-to-height ratio were associated with increased blood pressure. In craniopharyngioma patients with hypothalamic involvement/lesion or gross-total resection, rate and degree of obesity were increased. CONCLUSIONS NST could serve as a novel useful marker for regional nuchal adipose tissue. NST is highly associated with body mass and waist-to-height ratio, and easily measurable in routine MRI monitoring of brain tumor patients.
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Affiliation(s)
- Junxiang Peng
- Department of Pediatrics and Pediatric Hematology/Oncology, University Children’s Hospital, Klinikum Oldenburg AöR, Carl von Ossietzky University, Oldenburg, Germany
- Department of Neurosurgery, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Svenja Boekhoff
- Department of Pediatrics and Pediatric Hematology/Oncology, University Children’s Hospital, Klinikum Oldenburg AöR, Carl von Ossietzky University, Oldenburg, Germany
| | - Maria Eveslage
- Institute of Biostatistics and Clinical Research, University of Münster, Münster, Germany
| | - Brigitte Bison
- Department of Neuroradiology, University Hospital, Würzburg, Germany
| | - Panjarat Sowithayasakul
- Department of Pediatrics and Pediatric Hematology/Oncology, University Children’s Hospital, Klinikum Oldenburg AöR, Carl von Ossietzky University, Oldenburg, Germany
- Department of Pediatrics, Faculty of Medicine, Srinakharinwirot University, Bangkok, Thailand
| | - Carsten Friedrich
- Department of Pediatrics and Pediatric Hematology/Oncology, University Children’s Hospital, Klinikum Oldenburg AöR, Carl von Ossietzky University, Oldenburg, Germany
| | - Hermann L. Müller
- Department of Pediatrics and Pediatric Hematology/Oncology, University Children’s Hospital, Klinikum Oldenburg AöR, Carl von Ossietzky University, Oldenburg, Germany
- *Correspondence: Hermann L. Müller,
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van Santen SS, Olsson DS, Hammarstrand C, Wijnen M, Fiocco M, van den Heuvel-Eibrink MM, Johannsson G, Janssen JAMJL, van der Lely AJ, Neggers SJCMM. Body Composition and Bone Mineral Density in Craniopharyngioma Patients: A Longitudinal Study Over 10 Years. J Clin Endocrinol Metab 2020; 105:5900043. [PMID: 32869850 DOI: 10.1210/clinem/dgaa607] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 06/27/2020] [Indexed: 11/19/2022]
Abstract
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 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 Δtime 10.0 years; range 0.4-23.3) at age ≥ 18 years (58 [52%] male, 50 [45%] childhood onset). MAIN OUTCOME MEASURES Longitudinal changes of body composition and BMD, and associated factors of ΔZ-score (sex and age standardized). RESULTS BMI (from 28.8 ± 4.9 to 31.2 ± 5.1 kg/m2, P < .001), fat mass index (FMI) (from 10.5 ± 3.6 to 11.9 ± 3.8 kg/m2, P = .001), and fat free mass index (FFMI) (from 18.3 ± 3.2 to 19.1 ± 3.2 kg/m2, 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 ΔZ-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.
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Affiliation(s)
- Selveta S van Santen
- Department of Medicine, Endocrinology; Erasmus Medical Center, Rotterdam, The Netherlands
- Department of Paediatric Oncology/Haematology, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands
- Princess Máxima Center for Paediatric Oncology, Utrecht, The Netherlands
| | - Daniel S Olsson
- Department of Medicine, Endocrinology; Sahlgrenska University Hospital, Gothenburg, Sweden
- Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Casper Hammarstrand
- Department of Medicine, Endocrinology; Sahlgrenska University Hospital, Gothenburg, Sweden
- Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Mark Wijnen
- Department of Medicine, Endocrinology; Erasmus Medical Center, Rotterdam, The Netherlands
- Department of Paediatric Oncology/Haematology, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Marta Fiocco
- Princess Máxima Center for Paediatric Oncology, Utrecht, The Netherlands
- Mathematical Institute, Leiden University, Leiden, The Netherlands
- Department of Biomedical Data Sciences, Medical Statistics Section, Leiden University Medical Center, Leiden, The Netherlands
| | - Marry M van den Heuvel-Eibrink
- Department of Paediatric Oncology/Haematology, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands
- Princess Máxima Center for Paediatric Oncology, Utrecht, The Netherlands
| | - Gudmundur Johannsson
- Department of Medicine, Endocrinology; Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Joseph A M J L Janssen
- Department of Medicine, Endocrinology; Erasmus Medical Center, Rotterdam, The Netherlands
| | - Aart J van der Lely
- Department of Medicine, Endocrinology; Erasmus Medical Center, Rotterdam, The Netherlands
| | - Sebastian J C M M Neggers
- Department of Medicine, Endocrinology; Erasmus Medical Center, Rotterdam, The Netherlands
- Department of Paediatric Oncology/Haematology, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands
- Princess Máxima Center for Paediatric Oncology, Utrecht, The Netherlands
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Nuijts MA, Veldhuis N, Stegeman I, van Santen HM, Porro GL, Imhof SM, Schouten–van Meeteren AYN. Visual functions in children with craniopharyngioma at diagnosis: A systematic review. PLoS One 2020; 15:e0240016. [PMID: 33002047 PMCID: PMC7529266 DOI: 10.1371/journal.pone.0240016] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 09/18/2020] [Indexed: 02/06/2023] Open
Abstract
Childhood craniopharyngioma is a rare and slow growing brain tumour, often located in the sellar and suprasellar region. It commonly manifests with visual impairment, increased intracranial pressure and hypothalamic and/or pituitary deficiencies. Visual impairment in childhood adversely affects a child’s daily functioning and quality of life. We systematically reviewed the literature to provide an extensive overview of the visual function in children with craniopharyngioma at diagnosis in order to estimate the diversity, magnitude and relevance of the problem of visual impairment. Of the 543 potentially relevant articles, 84 studies met our inclusion criteria. Visual impairment at diagnosis was reported in 1041 of 2071 children (50.3%), decreased visual acuity was reported in 546 of 1321 children (41.3%) and visual field defects were reported in 426 of 1111 children (38.3%). Other ophthalmological findings described were fundoscopic (32.5%) and orthoptic abnormalities (12.5%). Variations in ophthalmological testing methods and ophthalmological definitions precluded a meta-analysis. The results of this review confirm the importance of ophthalmological examination in children with craniopharyngioma at diagnosis in order to detect visual impairment and provide adequate support. Future studies should focus on long-term visual follow-up of childhood craniopharyngioma in response to different treatment strategies to provide insight in risks and ways to prevent further loss of vision.
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Affiliation(s)
- Myrthe A. Nuijts
- Department of Ophthalmology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
- * E-mail:
| | - Nienke Veldhuis
- Faculty of Medicine, Utrecht University, Utrecht, The Netherlands
| | - Inge Stegeman
- Department of Ophthalmology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Hanneke M. van Santen
- Department of Pediatric Endocrinology, Wilhelmina Children’s Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Giorgio L. Porro
- Department of Ophthalmology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Saskia M. Imhof
- Department of Ophthalmology, University Medical Center Utrecht, Utrecht, The Netherlands
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Prieto R, Rosdolsky M, Hofecker V, Barrios L, Pascual JM. Craniopharyngioma treatment: an updated summary of important clinicopathological concepts. Expert Rev Endocrinol Metab 2020; 15:261-282. [PMID: 32615875 DOI: 10.1080/17446651.2020.1770081] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 05/13/2020] [Indexed: 01/19/2023]
Abstract
INTRODUCTION Craniopharyngiomas (CPs) are benign histological tumors that may develop at different positions along the hypothalamic-pituitary axis. Their close, heterogenous relationship to the hypothalamus makes surgical removal challenging even though this remains the primary treatment strategy. AREAS COVERED This article presents a critical overview of the pathological and clinical concepts regarding CPs that should be considered when planning treatment. Thus, we have performed a comprehensive review of detailed CP reports published between 1839 and 2020. EXPERT OPINION CP surgery should pursue maximal tumor resection while minimizing the risk of injuring the hypothalamus. Therefore, surgical strategies should be individualized for each patient. Accurate assessment of presenting symptoms and preoperative MRI has proven useful to predict the type of CP-hypothalamus relationship that will be found during surgery. CPs with dense and extensive adhesions to the hypothalamus should be highly suspected when MRI shows the hypothalamus positioned around the mid-third of the tumor and an amputated upper portion of the pituitary stalk. Symptoms related to functional impairment of the infundibulo-tuberal area of the third ventricle floor, such as obesity/hyperphagia, Fröhlich's syndrome, diabetes insipidus, and/or somnolence, also indicate risky CP-hypothalamic adhesions. In these cases, limited tumor removal is strongly advocated followed by radiation therapy.
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Affiliation(s)
- Ruth Prieto
- Department of Neurosurgery, Puerta de Hierro University Hospital , Madrid, Spain
| | | | - Verena Hofecker
- Pathologisch-anatomische Sammlung Im Narrenturm - NHM , Vienna, Austria
| | - Laura Barrios
- Statistics Department, Computing Center, CSIC , Madrid, Spain
| | - José M Pascual
- Department of Neurosurgery, La Princesa University Hospital , Madrid, Spain
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van Santen SS, Olsson DS, van den Heuvel-Eibrink MM, Wijnen M, Hammarstrand C, Janssen JAMJL, Johannsson G, van der Lely AJ, Neggers SJCMM. Fractures, Bone Mineral Density, and Final Height in Craniopharyngioma Patients with a Follow-up of 16 Years. J Clin Endocrinol Metab 2020; 105:dgz279. [PMID: 32145029 PMCID: PMC7060760 DOI: 10.1210/clinem/dgz279] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Accepted: 12/18/2019] [Indexed: 12/29/2022]
Abstract
CONTEXT Pituitary hormonal deficiencies in patients with craniopharyngioma may impair their bone health. OBJECTIVE To investigate bone health in patients with craniopharyngioma. DESIGN Retrospective cross-sectional study. SETTING Dutch and Swedish referral centers. PATIENTS Patients with craniopharyngioma (n = 177) with available data on bone health after a median follow-up of 16 years (range, 1-62) were included (106 [60%] Dutch, 93 [53%] male, 84 [48%] childhood-onset disease). MAIN OUTCOME MEASURES Fractures, dual X-ray absorptiometry-derived bone mineral density (BMD), and final height were evaluated. Low BMD was defined as T- or Z-score ≤-1 and very low BMD as ≤-2.5 or ≤-2.0, respectively. RESULTS Fractures occurred in 31 patients (18%) and were more frequent in men than in women (26% vs. 8%, P = .002). Mean BMD was normal (Z-score total body 0.1 [range, -4.1 to 3.5]) but T- or Z-score ≤-1 occurred in 47 (50%) patients and T-score ≤-2.5 or Z-score ≤-2.0 in 22 (24%) patients. Men received less often treatment for low BMD than women (7% vs. 18%, P = .02). Female sex (OR 0.3, P = .004) and surgery (odds ratio [OR], 0.2; P = .01) were both independent protective factors for fractures, whereas antiepileptic medication was a risk factor (OR, 3.6; P = .03), whereas T-score ≤-2.5 or Z-score ≤-2.0 was not (OR, 2.1; P = .21). Mean final height was normal and did not differ between men and women, or adulthood and childhood-onset patients. CONCLUSIONS Men with craniopharyngioma are at higher risk than women for fractures. In patients with craniopharyngioma, a very low BMD (T-score ≤-2.5 or Z-score ≤-2.0) seems not to be a good predictor for fracture risk.
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Affiliation(s)
- Selveta S van Santen
- Department of Medicine, Endocrinology; Erasmus Medical Center, GD Rotterdam, The Netherlands
- Department of Paediatric Oncology/Haematology, Erasmus MC – Sophia Children’s Hospital, CN Rotterdam, The Netherlands
- Princess Máxima Center for Paediatric Oncology, CS Utrecht, The Netherlands
| | - Daniel S Olsson
- Department of Medicine, Endocrinology; Sahlgrenska University Hospital, Gothenburg, Sweden
- Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Marry M van den Heuvel-Eibrink
- Department of Paediatric Oncology/Haematology, Erasmus MC – Sophia Children’s Hospital, CN Rotterdam, The Netherlands
- Princess Máxima Center for Paediatric Oncology, CS Utrecht, The Netherlands
| | - Mark Wijnen
- Department of Medicine, Endocrinology; Erasmus Medical Center, GD Rotterdam, The Netherlands
- Department of Paediatric Oncology/Haematology, Erasmus MC – Sophia Children’s Hospital, CN Rotterdam, The Netherlands
| | - Casper Hammarstrand
- Department of Medicine, Endocrinology; Sahlgrenska University Hospital, Gothenburg, Sweden
- Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Joseph A M J L Janssen
- Department of Medicine, Endocrinology; Erasmus Medical Center, GD Rotterdam, The Netherlands
| | - Gudmundur Johannsson
- Department of Medicine, Endocrinology; Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Aart J van der Lely
- Department of Medicine, Endocrinology; Erasmus Medical Center, GD Rotterdam, The Netherlands
| | - Sebastian J C M M Neggers
- Department of Medicine, Endocrinology; Erasmus Medical Center, GD Rotterdam, The Netherlands
- Department of Paediatric Oncology/Haematology, Erasmus MC – Sophia Children’s Hospital, CN Rotterdam, The Netherlands
- Princess Máxima Center for Paediatric Oncology, CS Utrecht, The Netherlands
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Crabtree VM, Klages KL, Sykes A, Wise MS, Lu Z, Indelicato D, Merchant TE, Avent Y, Mandrell BN. Sensitivity and Specificity of the Modified Epworth Sleepiness Scale in Children With Craniopharyngioma. J Clin Sleep Med 2019; 15:1487-1493. [PMID: 31596214 PMCID: PMC6778340 DOI: 10.5664/jcsm.7982] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Revised: 05/29/2019] [Accepted: 05/29/2019] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES Children with craniopharyngioma are at risk for excessive daytime sleepiness (EDS). Multiple Sleep Latency Testing (MSLT) is the gold standard for objective evaluation of EDS; however, it is time and resource intensive. We compared the reliability, sensitivity, and specificity of the modified Epworth Sleepiness Scale (M-ESS) and MSLT in monitoring EDS in children with craniopharyngioma. METHODS Seventy patients (ages 6 to 20 years) with craniopharyngioma completed the M-ESS and were evaluated by polysomnography and MSLT. Evaluations were made after surgery, if performed, and before proton therapy. RESULTS MSLT revealed that 66 participants (81.8%) had EDS, as defined by a mean sleep latency (MSL) < 10 minutes, with only 28.8% reporting EDS on the M-ESS by using a cutoff score of 10. The M-ESS demonstrated adequate internal consistency and specificity (91.7%) but poor sensitivity (33.3%) with the established cutoff score of 10. A cutoff score of 6 improved the sensitivity to 64.8% but decreased the specificity to 66.7%. CONCLUSIONS Patients with craniopharyngioma are at high risk for EDS, as documented objectively on the MSLT, but they frequently do not recognize or accurately report their sleepiness. Future sleep studies should investigate whether specific items or alternative self- and parent-reported measures of sleepiness may have greater clinical utility in monitoring sleepiness in this population.
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Affiliation(s)
| | - Kimberly Lauren Klages
- Department of Psychology, St. Jude Children’s Research Hospital, Memphis, Tennessee
- Department of Psychology, The University of Memphis, Memphis, Tennessee
| | - April Sykes
- Department of Biostatistics, St. Jude Children’s Research Hospital, Memphis, Tennessee
| | - Merrill S. Wise
- Methodist Healthcare Sleep Disorders Center, Memphis, Tennessee
| | - Zhaohua Lu
- Department of Biostatistics, St. Jude Children’s Research Hospital, Memphis, Tennessee
| | - Daniel Indelicato
- University of Florida Health Proton Therapy Institute, Jacksonville, Florida
| | - Thomas E. Merchant
- Department of Radiation Oncology, St. Jude Children’s Research Hospital, Memphis, Tennessee
| | - Yvonne Avent
- Department of Pediatric Medicine, Division of Nursing Research, St. Jude Children’s Research Hospital, Memphis, Tennessee
| | - Belinda N. Mandrell
- Department of Pediatric Medicine, Division of Nursing Research, St. Jude Children’s Research Hospital, Memphis, Tennessee
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10
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Carreno G, Boult JKR, Apps J, Gonzalez-Meljem JM, Haston S, Guiho R, Stache C, Danielson LS, Koers A, Smith LM, Virasami A, Panousopoulos L, Buchfelder M, Jacques TS, Chesler L, Robinson SP, Martinez-Barbera JP. SHH pathway inhibition is protumourigenic in adamantinomatous craniopharyngioma. Endocr Relat Cancer 2019; 26:355-366. [PMID: 30645190 PMCID: PMC6378366 DOI: 10.1530/erc-18-0538] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Accepted: 01/15/2019] [Indexed: 12/12/2022]
Abstract
Pharmacological inhibition of the sonic hedgehog (SHH) pathway can be beneficial against certain cancers but detrimental in others. Adamantinomatous craniopharyngioma (ACP) is a relevant pituitary tumour, affecting children and adults, that is associated with high morbidity and increased mortality in long-term follow-up. We have previously demonstrated overactivation of the SHH pathway in both human and mouse ACP. Here, we show that this activation is ligand dependent and induced by the expression of SHH protein in a small proportion of tumour cells. We investigate the functional relevance of SHH signalling in ACP through MRI-guided preclinical studies using an ACP mouse model. Treatment with vismodegib, a clinically approved SHH pathway inhibitor, results in a significant reduction in median survival due to premature development of highly proliferative and vascularised undifferentiated tumours. Reinforcing the mouse data, SHH pathway inhibition in human ACP leads to a significant increase in tumour cell proliferation both ex vivo, in explant cultures, and in vivo, in a patient-derived xenograft model. Together, our results demonstrate a protumourigenic effect of vismodegib-mediated SHH pathway inhibition in ACP.
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Affiliation(s)
- G Carreno
- Developmental Biology and Cancer Programme, Birth Defects Research Centre, Great Ormond Street Institute of Child Health, University College London, London, UK
| | - J K R Boult
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, UK
| | - J Apps
- Developmental Biology and Cancer Programme, Birth Defects Research Centre, Great Ormond Street Institute of Child Health, University College London, London, UK
| | - J M Gonzalez-Meljem
- Developmental Biology and Cancer Programme, Birth Defects Research Centre, Great Ormond Street Institute of Child Health, University College London, London, UK
- Basic Research Department, Instituto Nacional de Geriatría, Mexico City, Mexico
| | - S Haston
- Developmental Biology and Cancer Programme, Birth Defects Research Centre, Great Ormond Street Institute of Child Health, University College London, London, UK
| | - R Guiho
- Developmental Biology and Cancer Programme, Birth Defects Research Centre, Great Ormond Street Institute of Child Health, University College London, London, UK
| | - C Stache
- Developmental Biology and Cancer Programme, Birth Defects Research Centre, Great Ormond Street Institute of Child Health, University College London, London, UK
| | - L S Danielson
- Division of Clinical Studies and Cancer Therapeutics Division, Paediatric Solid Tumour Biology and Therapeutics Team, The Institute of Cancer Research, London, UK
| | - A Koers
- Division of Clinical Studies and Cancer Therapeutics Division, Paediatric Solid Tumour Biology and Therapeutics Team, The Institute of Cancer Research, London, UK
| | - L M Smith
- Division of Clinical Studies and Cancer Therapeutics Division, Paediatric Solid Tumour Biology and Therapeutics Team, The Institute of Cancer Research, London, UK
| | - A Virasami
- Department of Histopathology, Great Ormond Street Hospital for Children, NHS Foundation Trust, London, UK
| | - L Panousopoulos
- Developmental Biology and Cancer Programme, Birth Defects Research Centre, Great Ormond Street Institute of Child Health, University College London, London, UK
| | - M Buchfelder
- Department of Neurosurgery, University Hospital Erlangen, Erlangen, Germany
| | - T S Jacques
- Developmental Biology and Cancer Programme, Birth Defects Research Centre, Great Ormond Street Institute of Child Health, University College London, London, UK
- Department of Histopathology, Great Ormond Street Hospital for Children, NHS Foundation Trust, London, UK
| | - L Chesler
- Division of Clinical Studies and Cancer Therapeutics Division, Paediatric Solid Tumour Biology and Therapeutics Team, The Institute of Cancer Research, London, UK
| | - S P Robinson
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, UK
| | - J P Martinez-Barbera
- Developmental Biology and Cancer Programme, Birth Defects Research Centre, Great Ormond Street Institute of Child Health, University College London, London, UK
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11
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Tosta-Hernandez PDC, Siviero-Miachon AA, da Silva NS, Cappellano A, Pinheiro MDM, Spinola-Castro AM. Childhood Craniopharyngioma: A 22-Year Challenging Follow-Up in a Single Center. Horm Metab Res 2018; 50:675-682. [PMID: 29959763 DOI: 10.1055/a-0641-5956] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Craniopharyngioma is a sellar/suprasellar benign tumor whose aggressiveness may imply in endocrine disturbances (hypothalamic obesity and hormone deficiencies). Fifty-seven patients were evaluated according to clinical characteristics, hypothalamic involvement, type of treatment, anthropometric variables, adiposity indexes (body mass index Z score category at diagnosis and post-treatment, total body fat, visceral adipose tissue, and metabolic syndrome components) and analyzed through multiple regression and logistic models. Patients were stratified according to growth hormone deficiency and recombinant human growth hormone use. Mean ages at diagnosis and at study evaluation were 9.6 and 16.6 years old, respectively. A set of 43/57 (75.4%) patients presented with important hypothalamic involvement, 24/57 (42.1%) received surgical treatment and cranial radiotherapy, and 8/57 (14%) interferon-α exclusively. Fifty-five patients (96.5%) were considered growth hormone deficient, and 26/57 (45.6%) grew despite no recombinant human growth hormone replacement therapy. At diagnosis, 12/57 (21%) patients were obese, and 33/57 (57.9%) at study evaluation, and after 3.2 years (median) post first therapy. There was no influence of height Z score on body mass index Z score. Body mass index Z score at diagnosis positively influenced body mass index Z score, total body fat, waist circumference and the presence of the metabolic syndrome post-treatment. Replacement of recombinant human growth hormone decreased total body fat and visceral adipose tissue. Craniopharyngioma patients worsened body mass index Z score category 3.2 years (median) after first treatment. Body mass index Z score increased due to real weight gain, without height decrease. Replacement of recombinant human growth hormone had beneficial effect on adiposity.
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Affiliation(s)
- Patrícia Débora Cavalcanti Tosta-Hernandez
- Pediatric Endocrinology Division, Federal University of São Paulo - UNIFESP/EPM, São Paulo, Brazil
- Pediatric Oncology Institute, Federal University of São Paulo - IOP/GRAACC - UNIFESP/EPM, São Paulo, Brazil
| | - Adriana Aparecida Siviero-Miachon
- Pediatric Endocrinology Division, Federal University of São Paulo - UNIFESP/EPM, São Paulo, Brazil
- Pediatric Oncology Institute, Federal University of São Paulo - IOP/GRAACC - UNIFESP/EPM, São Paulo, Brazil
| | - Nasjla Saba da Silva
- Pediatric Oncology Institute, Federal University of São Paulo - IOP/GRAACC - UNIFESP/EPM, São Paulo, Brazil
| | - Andrea Cappellano
- Pediatric Oncology Institute, Federal University of São Paulo - IOP/GRAACC - UNIFESP/EPM, São Paulo, Brazil
| | | | - Angela Maria Spinola-Castro
- Pediatric Endocrinology Division, Federal University of São Paulo - UNIFESP/EPM, São Paulo, Brazil
- Pediatric Oncology Institute, Federal University of São Paulo - IOP/GRAACC - UNIFESP/EPM, São Paulo, Brazil
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12
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Haston S, Pozzi S, Carreno G, Manshaei S, Panousopoulos L, Gonzalez-Meljem JM, Apps JR, Virasami A, Thavaraj S, Gutteridge A, Forshew T, Marais R, Brandner S, Jacques TS, Andoniadou CL, Martinez-Barbera JP. MAPK pathway control of stem cell proliferation and differentiation in the embryonic pituitary provides insights into the pathogenesis of papillary craniopharyngioma. Development 2017; 144:2141-2152. [PMID: 28506993 PMCID: PMC5482995 DOI: 10.1242/dev.150490] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Accepted: 05/03/2017] [Indexed: 01/19/2023]
Abstract
Despite the importance of the RAS-RAF-MAPK pathway in normal physiology and disease of numerous organs, its role during pituitary development and tumourigenesis remains largely unknown. Here, we show that the over-activation of the MAPK pathway, through conditional expression of the gain-of-function alleles BrafV600E and KrasG12D in the developing mouse pituitary, results in severe hyperplasia and abnormal morphogenesis of the gland by the end of gestation. Cell-lineage commitment and terminal differentiation are disrupted, leading to a significant reduction in numbers of most of the hormone-producing cells before birth, with the exception of corticotrophs. Of note, Sox2+ stem cells and clonogenic potential are drastically increased in the mutant pituitaries. Finally, we reveal that papillary craniopharyngioma (PCP), a benign human pituitary tumour harbouring BRAF p.V600E also contains Sox2+ cells with sustained proliferative capacity and disrupted pituitary differentiation. Together, our data demonstrate a crucial function of the MAPK pathway in controlling the balance between proliferation and differentiation of Sox2+ cells and suggest that persistent proliferative capacity of Sox2+ cells may underlie the pathogenesis of PCP.
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Affiliation(s)
- Scott Haston
- Developmental Biology and Cancer Programme, Birth Defects Research Centre, Great Ormond Street Institute of Child Health, University College London, London WC1N 1EH, UK
| | - Sara Pozzi
- Developmental Biology and Cancer Programme, Birth Defects Research Centre, Great Ormond Street Institute of Child Health, University College London, London WC1N 1EH, UK
| | - Gabriela Carreno
- Developmental Biology and Cancer Programme, Birth Defects Research Centre, Great Ormond Street Institute of Child Health, University College London, London WC1N 1EH, UK
| | - Saba Manshaei
- Developmental Biology and Cancer Programme, Birth Defects Research Centre, Great Ormond Street Institute of Child Health, University College London, London WC1N 1EH, UK
| | - Leonidas Panousopoulos
- Developmental Biology and Cancer Programme, Birth Defects Research Centre, Great Ormond Street Institute of Child Health, University College London, London WC1N 1EH, UK
| | - Jose Mario Gonzalez-Meljem
- Developmental Biology and Cancer Programme, Birth Defects Research Centre, Great Ormond Street Institute of Child Health, University College London, London WC1N 1EH, UK
| | - John R Apps
- Developmental Biology and Cancer Programme, Birth Defects Research Centre, Great Ormond Street Institute of Child Health, University College London, London WC1N 1EH, UK
| | - Alex Virasami
- Department of Histopathology, Great Ormond Street Hospital for Children NHS Foundation Trust, London WC1N 3NN, UK
| | - Selvam Thavaraj
- Head and Neck Pathology, Dental Institute, King's College London, London SE1 9RT, UK
| | - Alice Gutteridge
- Department of Pathology, UCL Cancer Institute, London WC1E 6DD, UK
| | - Tim Forshew
- Department of Pathology, UCL Cancer Institute, London WC1E 6DD, UK
| | - Richard Marais
- Molecular Oncology Group, Cancer Research UK Manchester Institute, The University of Manchester, Manchester M20 4BX, UK
| | - Sebastian Brandner
- Department of Neurodegenerative Disease, UCL Institute of Neurology, Queen Square, London WC1N 3BG, UK
- Division of Neuropathology, The National Hospital for Neurology and Neurosurgery, Queen Square, London WC1N 3BG, UK
| | - Thomas S Jacques
- Developmental Biology and Cancer Programme, Birth Defects Research Centre, Great Ormond Street Institute of Child Health, University College London, London WC1N 1EH, UK
- Department of Histopathology, Great Ormond Street Hospital for Children NHS Foundation Trust, London WC1N 3NN, UK
| | - Cynthia L Andoniadou
- Centre for Craniofacial and Regenerative Biology, King's College London, London SE1 9RT, UK
- Department of Internal Medicine III, Technische Universität Dresden, Dresden 01307, Germany
| | - Juan Pedro Martinez-Barbera
- Developmental Biology and Cancer Programme, Birth Defects Research Centre, Great Ormond Street Institute of Child Health, University College London, London WC1N 1EH, UK
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13
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Wijnen M, van den Heuvel-Eibrink MM, Janssen JAMJL, Catsman-Berrevoets CE, Michiels EMC, van Veelen-Vincent MLC, Dallenga AHG, van den Berge JH, van Rij CM, van der Lely AJ, Neggers SJCMM. Very long-term sequelae of craniopharyngioma. Eur J Endocrinol 2017; 176:755-767. [PMID: 28325825 DOI: 10.1530/eje-17-0044] [Citation(s) in RCA: 61] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Revised: 03/16/2017] [Accepted: 03/21/2017] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Studies investigating long-term health conditions in patients with craniopharyngioma are limited by short follow-up durations and generally do not compare long-term health effects according to initial craniopharyngioma treatment approach. In addition, studies comparing long-term health conditions between patients with childhood- and adult-onset craniopharyngioma report conflicting results. The objective of this study was to analyse a full spectrum of long-term health effects in patients with craniopharyngioma according to initial treatment approach and age group at craniopharyngioma presentation. DESIGN Cross-sectional study based on retrospective data. METHODS We studied a single-centre cohort of 128 patients with craniopharyngioma treated from 1980 onwards (63 patients with childhood-onset disease). Median follow-up since craniopharyngioma presentation was 13 years (interquartile range: 5-23 years). Initial craniopharyngioma treatment approaches included gross total resection (n = 25), subtotal resection without radiotherapy (n = 44), subtotal resection with radiotherapy (n = 25), cyst aspiration without radiotherapy (n = 8), and 90Yttrium brachytherapy (n = 21). RESULTS Pituitary hormone deficiencies (98%), visual disturbances (75%) and obesity (56%) were the most common long-term health conditions observed. Different initial craniopharyngioma treatment approaches resulted in similar long-term health effects. Patients with childhood-onset craniopharyngioma experienced significantly more growth hormone deficiency, diabetes insipidus, panhypopituitarism, morbid obesity, epilepsy and psychiatric conditions compared with patients with adult-onset disease. Recurrence-/progression-free survival was significantly lower after initial craniopharyngioma treatment with cyst aspiration compared with other therapeutic approaches. Survival was similar between patients with childhood- and adult-onset craniopharyngioma. CONCLUSIONS Long-term health conditions were comparable after different initial craniopharyngioma treatment approaches and were generally more frequent in patients with childhood- compared with adult-onset disease.
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Affiliation(s)
- Mark Wijnen
- Section EndocrinologyDepartment of Medicine, Pituitary Centre Rotterdam, Erasmus University Medical Centre, Rotterdam, the Netherlands
- Department of Paediatric Oncology/HaematologyErasmus MC - Sophia Children's Hospital, Rotterdam, the Netherlands
| | - Marry M van den Heuvel-Eibrink
- Department of Paediatric Oncology/HaematologyErasmus MC - Sophia Children's Hospital, Rotterdam, the Netherlands
- Princess Maxima Centre for Paediatric OncologyUtrecht, the Netherlands
| | - Joseph A M J L Janssen
- Section EndocrinologyDepartment of Medicine, Pituitary Centre Rotterdam, Erasmus University Medical Centre, Rotterdam, the Netherlands
| | | | - Erna M C Michiels
- Department of Paediatric Oncology/HaematologyErasmus MC - Sophia Children's Hospital, Rotterdam, the Netherlands
| | | | | | | | - Carolien M van Rij
- Department of Radiation OncologyPituitary Centre Rotterdam, Erasmus University Medical Centre, Rotterdam, the Netherlands
| | - Aart-Jan van der Lely
- Section EndocrinologyDepartment of Medicine, Pituitary Centre Rotterdam, Erasmus University Medical Centre, Rotterdam, the Netherlands
| | - Sebastian J C M M Neggers
- Section EndocrinologyDepartment of Medicine, Pituitary Centre Rotterdam, Erasmus University Medical Centre, Rotterdam, the Netherlands
- Department of Paediatric Oncology/HaematologyErasmus MC - Sophia Children's Hospital, Rotterdam, the Netherlands
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14
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Nogueira MC, Berbel Júnior AS, Koenigkam-Santos M, Moreira AC, Nonino CB, de Castro M. Nutritional and endocrinologic evaluation of patients with craniopharyngioma. Clin Nutr ESPEN 2015; 10:e213-e218. [PMID: 28531465 DOI: 10.1016/j.clnesp.2015.06.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2015] [Accepted: 06/12/2015] [Indexed: 11/17/2022]
Abstract
BACKGROUND & AIMS Lesions of hypothalamus or adjacent brain structures by the craniopharyngioma (CP) and/or its treatment, as well as changes in orexigenic and anorexigenic hormones, are possible pathogenic factors for the obesity observed in CP patients. This study assessed anthropometric measurements, food intake, and biochemical markers of CP patients. METHODS Weight, height, skinfold thicknesses, circumferences, body composition, food intake evaluation, basal glucose, lipids, insulin, ghrelin, PYY, and HOMA-IR calculation were obtained from CP children (n = 10, 4F, aged 12 ± 4.2yr) and CP adults (n = 27,13F aged 42 ± 13 yr) and from 32 gender and age matched controls. RESULTS Overweight/obesity was observed in 51.4% of the patients at the diagnosis and increased to 86.5% at the time of the study. Obesity was more frequent in patients with grade 2 hypothalamic involvement. Most anthropometric measurements were similar in patients and controls. Caloric intake was lower in CP adults, without difference between children. Lipid intake was higher in CP patients. Carbohydrate and protein intakes were lower in CP children, with no difference between adult groups. There were no differences in micronutrients intake as well as in insulin and PYY levels, and HOMA-IR between patients and controls. HDL-c was lower in CP adults and ghrelin higher in CP children. CONCLUSIONS There is a high rate of overweight/obesity in CP patients at the diagnosis and throughout the follow-up period. Obesity was associated with degree of hypothalamic involvement but not with caloric intake. Obesity and a lipid rich diet may have contributed to the dyslipidemia observed in CP patients.
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Affiliation(s)
- Mônica Cristina Nogueira
- Department of Internal Medicine, Ribeirao Preto Medical School - University of São Paulo, Ribeirão Preto, SP, Brazil.
| | - Alfredo Sérgio Berbel Júnior
- Department of Internal Medicine, Ribeirao Preto Medical School - University of São Paulo, Ribeirão Preto, SP, Brazil.
| | - Marcel Koenigkam-Santos
- Department of Internal Medicine, Ribeirao Preto Medical School - University of São Paulo, Ribeirão Preto, SP, Brazil.
| | - Ayrton Custódio Moreira
- Department of Internal Medicine, Ribeirao Preto Medical School - University of São Paulo, Ribeirão Preto, SP, Brazil.
| | - Carla Barbosa Nonino
- Department of Internal Medicine, Ribeirao Preto Medical School - University of São Paulo, Ribeirão Preto, SP, Brazil.
| | - Margaret de Castro
- Department of Internal Medicine, Ribeirao Preto Medical School - University of São Paulo, Ribeirão Preto, SP, Brazil.
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15
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Castro-Dufourny I, Carrasco R, Prieto R, Barrios L, Pascual JM. The infundibulo-tuberal syndrome caused by craniopharyngiomas: clinicopathological evidence from an historical French cohort (1705-1973). Pituitary 2015; 18:642-57. [PMID: 25527245 DOI: 10.1007/s11102-014-0623-4] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
PURPOSE Infundibulo-tuberal syndrome groups endocrine, metabolic and behavioral disturbances caused by lesions involving the upper neurohypophysis (median eminence) and adjacent basal hypothalamus (tuber cinereum). It was originally described by Henri Claude and Jean Lhermitte in 1917, in a patient with a craniopharyngioma. This study investigates the clinical, pathological and surgical evidence verifying the infundibulo-tuberal syndrome caused by craniopharyngiomas (CPs). METHODS A systematic retrospective review of craniopharyngiomas reported in French literature between 1705 and 1973 was conducted. A total of 128 well described reports providing a comprehensive clinical and pathological description of the tumors were selected. This series represents the historical French cohort of CPs reported in the pre-CT/MRI era. RESULTS Three major syndromes caused by CPs were categorized: pituitary syndrome (35%), infundibulo-tuberal syndrome (52%) and hypothalamic syndrome (49%). CP topography was significantly related to the type of syndrome described (p < 0.001). Infundibulo-tuberal syndrome occurred in CPs which replaced or invaded the third ventricle floor. In contrast, the majority of sellar/suprasellar CPs growing below the third ventricle showed a pituitary syndrome (82%). Cases with hypothalamic syndrome were characterized by anatomical integrity of the pituitary gland and stalk (p = 0.033) and occurred predominantly in adults older than 41 years old (p < 0.005). Among infundibulo-tuberal symptoms, abnormal somnolence was not related with the presence of hydrocephalus. All squamous-papillary CPs presented psychiatric disturbances (p < 0.001). CONCLUSION This historical CP cohort evidences a clinical-topographical correlation between the patient's type of syndrome and the anatomical structures involved by the tumor along the hypophysial-hypothalamic axis.
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Affiliation(s)
- Inés Castro-Dufourny
- Department of Endocrinology, Sureste University Hospital, C/Ronda del Sur 10, Arganda del Rey, 28500, Madrid, Spain,
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16
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Joustra SD, Thijs RD, van den Berg R, van Dijk M, Pereira AM, Lammers GJ, van Someren EJW, Romijn JA, Biermasz NR. Alterations in diurnal rhythmicity in patients treated for nonfunctioning pituitary macroadenoma: a controlled study and literature review. Eur J Endocrinol 2014; 171:217-28. [PMID: 24826835 DOI: 10.1530/eje-14-0172] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Patients treated for nonfunctioning pituitary macroadenomas (NFMAs) have fatigue and alterations in sleep characteristics and sleep-wake rhythmicity frequently. As NFMAs often compress the optic chiasm, these complaints might be related to dysfunction of the adjacent suprachiasmatic nucleus (SCN). We aimed to explore whether indirect indices of SCN functioning are altered in the long term after surgery for NFMAs. METHODS We studied 17 NFMA patients in long-term remission after transsphenoidal surgery, receiving adequate and stable hormone replacement for hypopituitarism, and 17 control subjects matched for age, gender, and BMI. Indirect indices of SCN function were assessed from 24-h ambulatory recordings of skin and core body temperatures, blood pressure, and salivary melatonin levels. Altered melatonin secretion was defined as an absence of evening rise, considerable irregularity, or daytime values >3 pg/ml. We additionally studied eight patients treated for craniopharyngioma. RESULTS Distal-proximal skin temperature gradient did not differ between NFMAs and control subjects, but proximal skin temperature was decreased during daytime (P=0.006). Core body temperature and non-dipping of blood pressure did not differ, whereas melatonin secretion was often altered in NFMAs (OR 5.3, 95% CI 0.9-30.6). One or more abnormal parameters (≥2.0 SDS of control subjects) were observed during nighttime in 12 NFMA patients and during daytime in seven NFMA patients. Similar patterns were observed in craniopharyngioma patients. CONCLUSION Heterogeneous patterns of altered diurnal rhythmicity in skin temperature and melatonin secretion parameters were observed in the majority of patients treated for NFMAs. On a group level, both NFMA and craniopharyngioma patients showed a lower daytime proximal skin temperature than control subjects, but other group averages were not significantly different. The observations suggest altered function of central (or peripheral) clock machinery, possibly by disturbed entrainment or damage of the hypothalamic SCN by the suprasellar macroadenoma or its treatment.
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Affiliation(s)
- S D Joustra
- Center for Endocrine Tumors LeidenDepartment of Endocrinology and MetabolismDepartment of NeurologyLeiden University Medical Center, Albinusdreef 2, 2333ZA Leiden, The NetherlandsStichting Epilepsie Instellingen Nederland (SEIN)Achterweg 5, 2103SW Heemstede, The NetherlandsDepartment of Sleep and CognitionNetherlands Institute for Neuroscience, Meibergdreef 47, 1105BA Amsterdam, The NetherlandsNeuroscience Campus AmsterdamDepartments of Integrative Neurophysiology and Medical Psychology, VU University and Medical Center, De Boelelaan 1117, 1081HZ Amsterdam, The Netherlands
| | - R D Thijs
- Center for Endocrine Tumors LeidenDepartment of Endocrinology and MetabolismDepartment of NeurologyLeiden University Medical Center, Albinusdreef 2, 2333ZA Leiden, The NetherlandsStichting Epilepsie Instellingen Nederland (SEIN)Achterweg 5, 2103SW Heemstede, The NetherlandsDepartment of Sleep and CognitionNetherlands Institute for Neuroscience, Meibergdreef 47, 1105BA Amsterdam, The NetherlandsNeuroscience Campus AmsterdamDepartments of Integrative Neurophysiology and Medical Psychology, VU University and Medical Center, De Boelelaan 1117, 1081HZ Amsterdam, The NetherlandsCenter for Endocrine Tumors LeidenDepartment of Endocrinology and MetabolismDepartment of NeurologyLeiden University Medical Center, Albinusdreef 2, 2333ZA Leiden, The NetherlandsStichting Epilepsie Instellingen Nederland (SEIN)Achterweg 5, 2103SW Heemstede, The NetherlandsDepartment of Sleep and CognitionNetherlands Institute for Neuroscience, Meibergdreef 47, 1105BA Amsterdam, The NetherlandsNeuroscience Campus AmsterdamDepartments of Integrative Neurophysiology and Medical Psychology, VU University and Medical Center, De Boelelaan 1117, 1081HZ Amsterdam, The Netherlands
| | - R van den Berg
- Center for Endocrine Tumors LeidenDepartment of Endocrinology and MetabolismDepartment of NeurologyLeiden University Medical Center, Albinusdreef 2, 2333ZA Leiden, The NetherlandsStichting Epilepsie Instellingen Nederland (SEIN)Achterweg 5, 2103SW Heemstede, The NetherlandsDepartment of Sleep and CognitionNetherlands Institute for Neuroscience, Meibergdreef 47, 1105BA Amsterdam, The NetherlandsNeuroscience Campus AmsterdamDepartments of Integrative Neurophysiology and Medical Psychology, VU University and Medical Center, De Boelelaan 1117, 1081HZ Amsterdam, The Netherlands
| | - M van Dijk
- Center for Endocrine Tumors LeidenDepartment of Endocrinology and MetabolismDepartment of NeurologyLeiden University Medical Center, Albinusdreef 2, 2333ZA Leiden, The NetherlandsStichting Epilepsie Instellingen Nederland (SEIN)Achterweg 5, 2103SW Heemstede, The NetherlandsDepartment of Sleep and CognitionNetherlands Institute for Neuroscience, Meibergdreef 47, 1105BA Amsterdam, The NetherlandsNeuroscience Campus AmsterdamDepartments of Integrative Neurophysiology and Medical Psychology, VU University and Medical Center, De Boelelaan 1117, 1081HZ Amsterdam, The Netherlands
| | - A M Pereira
- Center for Endocrine Tumors LeidenDepartment of Endocrinology and MetabolismDepartment of NeurologyLeiden University Medical Center, Albinusdreef 2, 2333ZA Leiden, The NetherlandsStichting Epilepsie Instellingen Nederland (SEIN)Achterweg 5, 2103SW Heemstede, The NetherlandsDepartment of Sleep and CognitionNetherlands Institute for Neuroscience, Meibergdreef 47, 1105BA Amsterdam, The NetherlandsNeuroscience Campus AmsterdamDepartments of Integrative Neurophysiology and Medical Psychology, VU University and Medical Center, De Boelelaan 1117, 1081HZ Amsterdam, The Netherlands
| | - G J Lammers
- Center for Endocrine Tumors LeidenDepartment of Endocrinology and MetabolismDepartment of NeurologyLeiden University Medical Center, Albinusdreef 2, 2333ZA Leiden, The NetherlandsStichting Epilepsie Instellingen Nederland (SEIN)Achterweg 5, 2103SW Heemstede, The NetherlandsDepartment of Sleep and CognitionNetherlands Institute for Neuroscience, Meibergdreef 47, 1105BA Amsterdam, The NetherlandsNeuroscience Campus AmsterdamDepartments of Integrative Neurophysiology and Medical Psychology, VU University and Medical Center, De Boelelaan 1117, 1081HZ Amsterdam, The NetherlandsCenter for Endocrine Tumors LeidenDepartment of Endocrinology and MetabolismDepartment of NeurologyLeiden University Medical Center, Albinusdreef 2, 2333ZA Leiden, The NetherlandsStichting Epilepsie Instellingen Nederland (SEIN)Achterweg 5, 2103SW Heemstede, The NetherlandsDepartment of Sleep and CognitionNetherlands Institute for Neuroscience, Meibergdreef 47, 1105BA Amsterdam, The NetherlandsNeuroscience Campus AmsterdamDepartments of Integrative Neurophysiology and Medical Psychology, VU University and Medical Center, De Boelelaan 1117, 1081HZ Amsterdam, The Netherlands
| | - E J W van Someren
- Center for Endocrine Tumors LeidenDepartment of Endocrinology and MetabolismDepartment of NeurologyLeiden University Medical Center, Albinusdreef 2, 2333ZA Leiden, The NetherlandsStichting Epilepsie Instellingen Nederland (SEIN)Achterweg 5, 2103SW Heemstede, The NetherlandsDepartment of Sleep and CognitionNetherlands Institute for Neuroscience, Meibergdreef 47, 1105BA Amsterdam, The NetherlandsNeuroscience Campus AmsterdamDepartments of Integrative Neurophysiology and Medical Psychology, VU University and Medical Center, De Boelelaan 1117, 1081HZ Amsterdam, The NetherlandsCenter for Endocrine Tumors LeidenDepartment of Endocrinology and MetabolismDepartment of NeurologyLeiden University Medical Center, Albinusdreef 2, 2333ZA Leiden, The NetherlandsStichting Epilepsie Instellingen Nederland (SEIN)Achterweg 5, 2103SW Heemstede, The NetherlandsDepartment of Sleep and CognitionNetherlands Institute for Neuroscience, Meibergdreef 47, 1105BA Amsterdam, The NetherlandsNeuroscience Campus AmsterdamDepartments of Integrative Neurophysiology and Medical Psychology, VU University and Medical Center, De Boelelaan 1117, 1081HZ Amsterdam, The Netherlands
| | - J A Romijn
- Center for Endocrine Tumors LeidenDepartment of Endocrinology and MetabolismDepartment of NeurologyLeiden University Medical Center, Albinusdreef 2, 2333ZA Leiden, The NetherlandsStichting Epilepsie Instellingen Nederland (SEIN)Achterweg 5, 2103SW Heemstede, The NetherlandsDepartment of Sleep and CognitionNetherlands Institute for Neuroscience, Meibergdreef 47, 1105BA Amsterdam, The NetherlandsNeuroscience Campus AmsterdamDepartments of Integrative Neurophysiology and Medical Psychology, VU University and Medical Center, De Boelelaan 1117, 1081HZ Amsterdam, The Netherlands
| | - N R Biermasz
- Center for Endocrine Tumors LeidenDepartment of Endocrinology and MetabolismDepartment of NeurologyLeiden University Medical Center, Albinusdreef 2, 2333ZA Leiden, The NetherlandsStichting Epilepsie Instellingen Nederland (SEIN)Achterweg 5, 2103SW Heemstede, The NetherlandsDepartment of Sleep and CognitionNetherlands Institute for Neuroscience, Meibergdreef 47, 1105BA Amsterdam, The NetherlandsNeuroscience Campus AmsterdamDepartments of Integrative Neurophysiology and Medical Psychology, VU University and Medical Center, De Boelelaan 1117, 1081HZ Amsterdam, The Netherlands
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17
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Abstract
OBJECTIVE To assess the influence of craniopharyngioma or consequent surgery on melatonin secretion, and the association with fatigue, sleepiness, sleep pattern and sleep quality. DESIGN Cross-sectional study. METHODS A total of 15 craniopharyngioma patients were individually matched to healthy controls. In this study, 24-h salivary melatonin and cortisol were measured. Sleep-wake patterns were characterised by actigraphy and sleep diaries recorded for 2 weeks. Sleepiness, fatigue, sleep quality and general health were assessed by Multidimensional Fatigue Inventory, Pittsburgh Sleep Quality Index, Epworth Sleepiness Scale and Short-Form 36. RESULTS Patients had increased mental fatigue, daytime dysfunction, sleep latency and lower general health (all, P≤0.05), and they tended to have increased daytime sleepiness, general fatigue and impaired sleep quality compared with controls. The degree of hypothalamic injury was associated with an increased BMI and lower mental health (P=0.01). High BMI was associated with increased daytime sleepiness, daytime dysfunction, mental fatigue and lower mental health (all, P≤0.01). Low midnight melatonin was associated with reduced sleep time and efficiency (P≤0.03) and a tendency for increased sleepiness, impaired sleep quality and physical health. Midnight melatonin remained independently related to sleep time after adjustment for cortisol. Three different patterns of melatonin profiles were observed; normal (n=6), absent midnight peak (n=6) and phase-shifted peak (n=2). Only patients with absent midnight peak had impaired sleep quality, increased daytime sleepiness and general and mental fatigue. CONCLUSION Craniopharyngioma patients present with changes in circadian pattern and daytime symptoms, which may be due to the influence of the craniopharyngioma or its treatment on the hypothalamic circadian and sleep regulatory nuclei.
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Affiliation(s)
- Line Pickering
- Department of EndocrinologyCopenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, DK-2100 Copenhagen East, DenmarkDanish Center for Sleep MedicineDepartment of Clinical BiochemistryCopenhagen University Hospital, Glostrup Hospital, Ndr. Ringvej 57, DK-2600 Glostrup, DenmarkDepartment of NeurosurgeryCopenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, DK-2100 Copenhagen East, Denmark
| | - Poul Jennum
- Department of EndocrinologyCopenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, DK-2100 Copenhagen East, DenmarkDanish Center for Sleep MedicineDepartment of Clinical BiochemistryCopenhagen University Hospital, Glostrup Hospital, Ndr. Ringvej 57, DK-2600 Glostrup, DenmarkDepartment of NeurosurgeryCopenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, DK-2100 Copenhagen East, Denmark
| | - Steen Gammeltoft
- Department of EndocrinologyCopenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, DK-2100 Copenhagen East, DenmarkDanish Center for Sleep MedicineDepartment of Clinical BiochemistryCopenhagen University Hospital, Glostrup Hospital, Ndr. Ringvej 57, DK-2600 Glostrup, DenmarkDepartment of NeurosurgeryCopenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, DK-2100 Copenhagen East, Denmark
| | - Lars Poulsgaard
- Department of EndocrinologyCopenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, DK-2100 Copenhagen East, DenmarkDanish Center for Sleep MedicineDepartment of Clinical BiochemistryCopenhagen University Hospital, Glostrup Hospital, Ndr. Ringvej 57, DK-2600 Glostrup, DenmarkDepartment of NeurosurgeryCopenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, DK-2100 Copenhagen East, Denmark
| | - Ulla Feldt-Rasmussen
- Department of EndocrinologyCopenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, DK-2100 Copenhagen East, DenmarkDanish Center for Sleep MedicineDepartment of Clinical BiochemistryCopenhagen University Hospital, Glostrup Hospital, Ndr. Ringvej 57, DK-2600 Glostrup, DenmarkDepartment of NeurosurgeryCopenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, DK-2100 Copenhagen East, Denmark
| | - Marianne Klose
- Department of EndocrinologyCopenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, DK-2100 Copenhagen East, DenmarkDanish Center for Sleep MedicineDepartment of Clinical BiochemistryCopenhagen University Hospital, Glostrup Hospital, Ndr. Ringvej 57, DK-2600 Glostrup, DenmarkDepartment of NeurosurgeryCopenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, DK-2100 Copenhagen East, Denmark
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18
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Abstract
OBJECTIVE Dysregulation of the autonomic nervous system is thought to be involved in craniopharyngioma-related hypothalamic obesity (CRHO). Increased parasympathetic activity and decreased sympathetic activity have been suggested. We aimed to study autonomic activity using heart rate variability (HRV) and biochemical measures in youth with CRHO compared with controls and to explore relationships between obesity and autonomic indices. DESIGN A cross-sectional study of 16 youth with CRHO and 16 controls matched for sex, age, and BMI. METHODS Anthropometrics, fasting blood-work, resting energy expenditure (REE), 24-h HRV, and 24-h urine catecholamines were assessed. Quality of life, sleepiness, and autonomic symptoms were evaluated. Power spectral analysis of the HRV was performed. RESULTS HRV power spectral analysis parameters of both parasympathetic activity (mean high frequency (HF (ms(2))) 611±504 vs 459±336, P=0.325) and sympathetic activity (median low frequency/HF 1.62 (1.37, 2.41) vs 1.89 (1.44, 2.99), P=0.650) did not differ between the groups. Parasympathetic activity negatively correlated with central adiposity in both groups (r=-0.53, P=0.034 and r=-0.54, P=0.029) and sympathetic activity positively correlated with central adiposity in CRHO (r=0.51, P=0.043). Youth with CRHO had significantly lower REE; lower health and activity scores in the quality of life questionnaires, and higher sleepiness scores. CONCLUSIONS Autonomic activity was similar in CRHO and control subjects. The degree of central adiposity correlated negatively with parasympathetic activity and positively with sympathetic activity in children with CRHO. These results provide a new perspective regarding autonomic balance in this unique patient population.
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Affiliation(s)
- Michal Cohen
- Division of Endocrinology, The Hospital for Sick Children, Toronto, Ontario, Canada
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19
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Abstract
BACKGROUND Patients with hypothalamic pathology often develop morbid obesity, causing severe metabolic alterations resulting in increased morbidity and mortality. Glucagon-like peptide-1 (GLP-1) analogues improve glycaemic control in type 2 diabetic patients and cause weight loss in obese patients by yet unknown mechanisms. Here we tested whether GLP-1 analogues were also effective in the treatment of obesity and associated metabolic alterations in patients with hypothalamic disease. METHODS Nine patients (eight with type 2 diabetes mellitus) with moderate to severe hypothalamic obesity were treated with GLP-1 analogues for up to 51 months. Body weight, homeostasis model assessment - insulin resistance (HOMA-IR), HbA1c and lipids were assessed. RESULTS Eight patients experienced substantial weight loss (-13.1±5.1 kg (range -9 to -22)). Insulin resistance (HOMA-IR -3.2±3.5 (range -9.1 to 0.8)) and HbA1c values (-1.3±1.4% (range -4.5 to 0.0)) improved under treatment (24.3±18.9 months (range 6 to 51)). Five patients reported increased satiation in response to the treatment. Two of the eight patients complained about nausea and vomiting and one of them abandoned therapy because of sustained gastrointestinal discomfort after 6 months. One patient suffered from intolerable nausea and vomiting and discontinued treatment within 2 weeks. CONCLUSION GLP-1 analogues can cause substantial and sustained weight loss in obese patients with hypothalamic disease. This offers a new approach for medical treatment of moderate to severe hypothalamic obesity and associated metabolic alterations.
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Affiliation(s)
- Flavius Zoicas
- Division of Endocrinology and Diabetes, Department of Medicine 1, Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany
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20
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Abstract
OBJECTIVE Patients with prolactinoma seem to be at high risk for osteopenia. However, whether patients with various pathological sellar tumors have risk for osteopenia remains unclear. The aim of the present study is to assess the bone mass alteration in patients with various sellar tumors and further to investigate the risk factors of bone mass alteration. MATERIALS AND METHODS 65 premenopausal female patients with diverse sellar tumors and 325 normal controls were enrolled in this study. Bone mineral density (BMD) of lumbar spine and comprehensive endocrinological evaluations were undergone. RESULTS Compared to the matched controls, BMD of patients with prolactinoma or craniopharyngioma significantly decreased. Patients with sellar meningioma and nonfunctioning adenoma are with a decreasing tendency and patients with growth hormone-secreting adenoma are with an increasing tendency compared to controls. Univariate and multivariate regression analysis indicated that the bone loss in prolactinomas was significantly correlated to disease duration and hypogonadism. CONCLUSION In the premenopausal women, patients with prolactinoma or craniopharyngioma are often accompanied with osteopenia or osteoporosis, and disease duration and hypogonadism are the risk factors of bone loss in prolactinoma. Continuous surveillance of BMD is recommended in patients with meningioma or nonfunctioning adenoma.
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Affiliation(s)
- Yongbo Zhao
- Institute of Neurosurgery, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi Province, China
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21
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Chen Y, Wang W, Wang DF, Sun FR, Miao F. [Clinical features of childhood Rathke's cysts]. Zhongguo Dang Dai Er Ke Za Zhi 2012; 14:632-633. [PMID: 22898288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Affiliation(s)
- Ye Chen
- Department of Pediatrics, Ruijin Hospital Affiliated to Shanghai Jiao Tong University, Shanghai 200025, China
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22
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Piguel X, Abraham P, Bouhours-Nouet N, Gatelais F, Dufresne S, Rouleau S, Coutant R. Impaired aerobic exercise adaptation in children and adolescents with craniopharyngioma is associated with hypothalamic involvement. Eur J Endocrinol 2012; 166:215-22. [PMID: 22096113 DOI: 10.1530/eje-11-0742] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Many patients treated for craniopharyngioma (CP) complain of a relative incapacity for physical activity. Whether this is due to an objective decrease in adaptation to exercise is unclear. We assessed exercise tolerance in children with surgically treated CP and appropriate pituitary hormone replacement therapy compared with healthy controls and we examined the potential relationships with hypothalamic involvement, GH replacement, and the catecholamine deficiency frequently observed in these subjects. DESIGN AND METHODS Seventeen subjects (12 males and five females) with CP and 22 healthy controls (14 males and eight females) aged 15.3±2.5 years (7.3-18 years) underwent a standardized cycle ergometer test. Maximum aerobic capacity was expressed as the ratio of VO(2max) to fat-free mass (VO(2max)/FFM), a measure independent of age and fat mass in children. RESULTS VO(2max)/FFM was 20% lower in children with CP compared with controls (P<0.05), even after adjustment for gender. Children with hypothalamic involvement (n=10) had a higher percentage of fat mass (P<0.05) than those without hypothalamic involvement (n=7) and lower VO(2max)/FFM (P<0.05), whereas children without hypothalamic involvement had VO(2max)/FFM close to that of controls (P>0.05). GH treatment was associated with a significant positive effect on aerobic capacity (P<0.05) only in the absence of hypothalamic involvement. No relationship was found between exercise capacity parameters and daily urine epinephrine excretion or epinephrine peak response to insulin-induced hypoglycemia. CONCLUSIONS Children with CP have a decrease in aerobic capacity mainly related to hypothalamic involvement. The hypothalamic factors altering aerobic capacity remain to be determined.
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Affiliation(s)
- Xavier Piguel
- Department of Pediatric Endocrinology, Angers University Hospital, 4 rue Larrey, 49033 Angers Cedex 01, France
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23
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Roth CL, Aylward E, Liang O, Kleinhans NM, Pauley G, Schur EA. Functional neuroimaging in craniopharyngioma: a useful tool to better understand hypothalamic obesity? Obes Facts 2012; 5:243-53. [PMID: 22647305 PMCID: PMC6902258 DOI: 10.1159/000338695] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2011] [Accepted: 11/08/2011] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVE To use functional magnetic resonance imaging (fMRI) in craniopharyngioma (CP) patients to examine the hypothesis that hypothalamic damage due to CP and its treatment results in enhanced perception of food reward and/or impaired central satiety processing. METHODS Pre- and post-meal responses to visual food cues in brain regions of interest (ROI; bilateral nucleus accumbens, bilateral insula, and medial orbitofrontal cortex) were assessed in 4 CP patients versus 4 age- and weight-matched controls. Stimuli consisted of images of high- ('fattening') and low-calorie ('non-fattening') foods in blocks, alternating with non-food object blocks. After the first fMRI scan, subjects drank a high-calorie test meal to suppress appetite, then completed a second fMRI scan. Within each ROI, we calculated mean z-scores for activation by fattening as compared to non-fattening food images. RESULTS Following the test meal, controls showed suppression of activation by food cues while CP patients showed trends towards higher activation. CONCLUSION These data, albeit in a small group of patients, support our hypothesis that perception of food cues may be altered in hypothalamic obesity (HO), especially after eating, i.e. in the satiated state. The fMRI approach is encouraging for performing future mechanistic studies of the brain response to food cues and satiety in patients with hypothalamic or other forms of childhood obesity.
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Affiliation(s)
- Christian L. Roth
- Seattle Children's Research Institute, Center of Integrative Brain Research, Seattle, WA, USA
- *Christian L. Roth, MD, Division of Endocrinology, Seattle Children's Hospital Research Institute, 1900 Ninth Avenue, Seattle, WA 98101 (USA), Tel. +1 206 987 5428, E-Mail
| | - Elizabeth Aylward
- Seattle Children's Research Institute, Center of Integrative Brain Research, Seattle, WA, USA
| | - Olivia Liang
- Department of Radiology and Integrated Brain Imaging Center, Seattle, WA, USA
| | | | - Gregory Pauley
- Department of Radiology and Integrated Brain Imaging Center, Seattle, WA, USA
| | - Ellen A. Schur
- Department of Medicine, University of Washington, Seattle, WA, USA
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24
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Holmer H, Popovic V, Ekman B, Follin C, Siversson AB, Erfurth EM. Hypothalamic involvement and insufficient sex steroid supplementation are associated with low bone mineral density in women with childhood onset craniopharyngioma. Eur J Endocrinol 2011; 165:25-31. [PMID: 21502326 DOI: 10.1530/eje-11-0229] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
CONTEXT Data on bone mineral density (BMD) are lacking in adults with childhood onset (CO)-craniopharyngioma (CP) with hypothalamic damage from the tumor. In patients with CO GH deficiency, BMD increases during GH treatment. OBJECTIVE The aims were to evaluate BMD in adults with CO-CPs on complete hormone replacement, including long-term GH and to evaluate the impact of hypothalamic damage on these measures. DESIGN AND PARTICIPANTS BMD (dual-energy X-ray absorptiometry), markers of bone turn over, physical activity and calcium intake were assessed in 39 CO-CP adults (20 women), with a median age of 28 (17-57) years, in comparison with matched population controls. RESULTS Late puberty induction was recorded in both genders, but reduced androgen levels in females only. Only CP women had lower BMD (P=0.03) at L2-L4, and reduced Z-scores at femoral neck (P=0.004) and L2-L4 (P=0.004). Both genders had increased serum leptin levels (P=0.001), which significantly correlated negatively with BMD at L2-L4 (P=0.003; r=-0.5) and 45% of CP women had Z-score levels ≤-2.0 s.d. Furthermore, 75% of those with a Z-score ≤-2.0 s.d. had hypothalamic involvement by the tumor. Calcium intake (P=0.008) and physical activity (P=0.007) levels were reduced in CP men only. Levels of ostecalcin and crossLaps were increased in CP men only. CONCLUSIONS Despite continuous GH therapy, low BMD was recorded in CO-CP females. Insufficient estrogen and androgen supplementation during adolescence was the main cause, but hypothalamic involvement with consequent leptin resistance was also strongly associated with low BMD in both genders.
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Affiliation(s)
- Helene Holmer
- Department of Internal Medicine, Central Hospital, SE 291 85 Kristianstad, Sweden
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25
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Bichpuria S, Joseph E, Mani S, Rajshekhar V, Bugalia V, Gibikote S. A retroclival cystic craniopharyngioma. Acta Neurol Belg 2010; 110:356-357. [PMID: 21305871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Affiliation(s)
- Sumit Bichpuria
- Department of Radiodiagnosis, Christian Medical College Hospital, Vellore, T.N. 632004, India.
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Kim RJ, Shah R, Tershakovec AM, Zemel BS, Sutton LN, Grimberg A, Moshang T. Energy expenditure in obesity associated with craniopharyngioma. Childs Nerv Syst 2010; 26:913-7. [PMID: 20107994 PMCID: PMC2883002 DOI: 10.1007/s00381-009-1078-1] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2009] [Accepted: 12/26/2009] [Indexed: 10/19/2022]
Abstract
BACKGROUND AND PURPOSE Obesity is a common yet incompletely understood complication of childhood craniopharyngioma. We hypothesized that craniopharyngioma is associated with specific defects in energy balance compared to obese control children. METHODS Eleven craniopharyngioma patients were recruited for a study on body composition and energy balance. Eight subjects were obese. The obese craniopharyngioma patients had a mean age (+/-SD) of 11.2 +/- 1.7 years. The average body mass index z score was 2.33 (+/-0.32). A previously studied group of obese children (BMI z score 2.46 +/- 0.46) served as controls. Resting energy expenditure (REE) was determined by indirect calorimetry and body composition by dual energy X-ray absorptiometry in all children. RESULTS Obese craniopharyngioma patient subjects had increased mean (+/-standard error) fat-free mass compared to obese controls (57% +/- 0.88 % vs 50.0% +/- 0.87%, p = 0.02). The obese craniopharyngioma patients had a 17% lower REE compared to values expected from the World Health Organization equation (1,541 +/- 112.6 vs 1,809 +/- 151.8 kcal; p = 0.01). In contrast, the obese control children had measured REE within 1% of predicted (1,647 +/- 33.2 vs. 1,652 +/- 40.2; p = 0.8). In a linear regression model, REE remained significantly lower than predicted after controlling for FFM. CONCLUSIONS Lower REE may be a factor contributing to obesity in children with craniopharyngioma. Further study is needed into the mechanisms for reduced energy expenditure in patients with craniopharyngioma.
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Affiliation(s)
- Roy J Kim
- Division of Endocrinology, Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA.
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27
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O'Gorman CS, Simoneau-Roy J, Pencharz P, MacFarlane J, MacLusky I, Narang I, Adeli K, Daneman D, Hamilton J. Sleep-disordered breathing is increased in obese adolescents with craniopharyngioma compared with obese controls. J Clin Endocrinol Metab 2010; 95:2211-8. [PMID: 20332250 DOI: 10.1210/jc.2009-2003] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
Abstract
CONTEXT Retrospective studies suggest that adolescents with craniopharyngioma and hypothalamic obesity have increased sleep-disordered breathing (SDB). OBJECTIVES The objectives of this study were to compare the prevalence of SDB in adolescents with craniopharyngioma-related obesity compared with body mass index (BMI)-matched controls and to explore possible relationships between SDB, insulin resistance, and adipocytokines. DESIGN This was a cross-sectional study of obese craniopharyngioma and obese control adolescents. SETTING Subjects were evaluated in the clinical investigation unit at the Hospital for Sick Children, Toronto. PATIENTS Fifteen patients with craniopharyngioma-related obesity and 15 BMI-matched controls were recruited and tested. INTERVENTIONS Each subject underwent fasting blood work, frequent sampled iv glucose tolerance test, polysomnography, and abdominal magnetic resonance imaging with calculation of visceral and sc adipose tissue. MAIN OUTCOME MEASURES Main measures included insulin sensitivity, sleep efficiency, and fragmentation. RESULTS Insulin sensitivity was lower in craniopharyngioma subjects compared with control subjects (0.96 +/- 0.34 vs. 1.67 +/- 0.7, P = 0.01). Sleep-onset latency (19.3 +/- 27.8 vs. 31.9 +/- 23.4, P = 0.03) and oxygen saturations (rapid eye movement sleep: 89.0 +/- 5.1 vs. 94.2 +/- 2.3, P < 0.001; non-rapid eye movement sleep: 88.4 +/- 5.6 vs. 94.3 +/- 1.5, P < 0.001) were lower in craniopharyngioma. Obstructive apnea-hypopnea index (OAHI) (7.5 +/- 9.0 vs. 1.5 +/- 1.5, P = 0.03) was higher in craniopharyngioma. Respiratory distress index and OAHI correlated negatively with adiponectin concentrations (r = -0.61, P = 0.03, r = -0.71, P = 0.006, respectively) in craniopharyngioma. On multiple regression, TNF-alpha and craniopharyngioma were independent positive predictors of sleep-onset latency and adiponectin and craniopharyngioma were significant predictors (negative and positive, respectively) of OAHI. CONCLUSIONS SDB is increased in adolescents with craniopharyngioma-related obesity compared with BMI-matched controls. Routine polysomnography should be considered in obese patients with craniopharyngioma and appropriate treatment initiated.
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Affiliation(s)
- Clodagh S O'Gorman
- Hospital for Sick Children, 555 University Avenue, Toronto, Ontario, Canada
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28
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Xu J, You C, Zhou L, Li Q, Zhou P, Chen N. The cell-cycle kinetics of craniopharyngioma and its clinical significance. J Neurooncol 2009; 98:71-6. [PMID: 19937088 DOI: 10.1007/s11060-009-0047-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2009] [Accepted: 10/26/2009] [Indexed: 02/05/2023]
Abstract
Craniopharyngioma (CP) is a pathologically benign tumor with high incidence of recurrence and poor prognosis. DNA ploidy, S-phase fraction (SPF), and G2 phase/mitosis phase + S phase (G2/M + S) measured by flow cytometry (FCM) have been shown to correlate with cell cycle characteristics and clinical prognosis of other tumors. By use of FCM and terminal deoxynucleotide transferase-mediated dUTP nick end labeling (TUNEL) peroxidase, we compared DNA content, SPF, G2/M + S, necrosis and apoptosis in non-recurrent and recurrent tumor cells of CP from 63 cases including 32 adamantine epitheliomas (AEs) and 31 squamous papillary tumors (SPTs), and the ultrastructure of the CP cell was observed by transmission electron microscopy. Although no obvious differences between DNA content and necrosis and apoptosis rate were observed in subgroups of CPs, SPF and G2/M + S for recurrent tumors were statistically higher than those for recurrence-free tumors, and the recurrence rate of AE tumors is higher than that of SPT. Therefore, CP cells are diploid, and SPF and G2/M + S are related to recurrence of CP.
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Affiliation(s)
- Jianguo Xu
- Department of Neurosurgery, West China Hospital, Sichuan University, 37# Guoxuexiang Street, 610041, Chengdu, People's Republic of China.
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Izycka-Swieszewska E, Swierkocka-Miastkowska M, Szurowska E, Lewandowska E, Wierzba-Bobrowicz T, Jodzio K. 31-year-old man with balint's syndrome and visual problems. Brain Pathol 2009; 19:527-30. [PMID: 19563545 DOI: 10.1111/j.1750-3639.2009.00300.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Abstract
INTRODUCTION Multimodal treatment in the management of giant craniopharyngiomas (>4 cm in diameter) is necessary to obtain optimal results, and includes conservative or palliative treatment and "aggressive" removal. The significance of a new treatment algorithm including direct surgical resection with the intent to avoid radiation therapy and regrowth will be discussed here. MATERIALS AND METHODS Between January 1996 and January 2005 16 patients were diagnosed with giant craniopharyngiomas. Two of them underwent only cyst aspiration because of their advanced age and/or lack of improvement of neuropsychological deficits. One patient underwent transsphenoidal operation and in the remaining 13 transcranial surgery was performed. Four additional patients underwent surgery for recurrence. The prospective protocol included pre- and post-operative dynamic endocrine tests, high field 1.5 T MRI and ophthalmological as well as neuropsychological examinations. RESULTS In resectable tumours, the rate of total removal was ten out of 12 with two recurrences. In the remaining two patients with recurrences this intention was abandoned because of a firm tumour or a deteriorating neuropsychological status prior to the scheduled additional operation. There was no mortality and the morbidity rate was 6.3%. Visual function improved in 11, was unchanged in one and deteriorated in two patients. Secretion of different adenohypophyseal hormones deteriorated after tumour resection in one to three patients, and new diabetes insipidus occurred in six patients. There was no permanent deterioration of neuropsychological function. CONCLUSION Special reference is given to direct resection of tumours at an optimal timing within this management. If hypothalamic disturbances are absent or improving due to pre-treatment (medical therapy, symptomatic surgery), giant craniopharyngiomas can be surgically removed in more than two of three patients with low morbidity and only moderate deterioration of endocrine function. The latter has to be accepted when curative surgery is intended, but even then, recurrences cannot be prevented. Contraindication for curative surgery is persisting hypothalamic damage necessitating conservative treatment modalities.
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Affiliation(s)
- R Fahlbusch
- Department of Neurosurgery, University of Erlangen-Nuremberg, Erlangen, Germany.
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van der Klaauw AA, Biermasz NR, Pereira AM, van Kralingen KW, Dekkers OM, Rabe KF, Smit JWA, Romijn JA. Patients cured from craniopharyngioma or nonfunctioning pituitary macroadenoma (NFMA) suffer similarly from increased daytime somnolence despite normal sleep patterns compared to healthy controls. Clin Endocrinol (Oxf) 2008; 69:769-74. [PMID: 18435832 DOI: 10.1111/j.1365-2265.2008.03284.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Adults patients previously treated for craniopharyngioma have increased general and physical fatigue compared to healthy controls. This could be related to disturbed sleep patterns. The aim of this study was to compare sleepiness and sleep patterns in those patients to healthy controls and to patients treated for nonfunctioning macroadenomas (NFMA) of the pituitary. DESIGN Case-control study. PATIENTS AND METHODS Sleepiness and sleep patterns were assessed in 27 adult patients [14 men, 8 patients diagnosed at childhood age, mean age of 53 years (range 27-80 year)] after long-term follow-up and compared to 50 healthy controls and 38 age-, gender- and BMI-matched patients with NFMA. We used two validated questionnaires for sleep parameters (Epworth sleepiness score and Münchener Chronotype Questionnaire). RESULTS Sleep patterns (onset, sleep timing, duration and rise time) were not statistically different between the three groups. However, daytime sleepiness scores were increased in patients treated for craniopharyngioma compared to healthy controls, but not different from patients with NFMA. Thirty-three percent of patients with craniopharyngiomas had ESS scores above 10 compared to 8% of healthy controls (P = 0.005), indicating severe daytime hypersomnolence. Neither type of surgery, previous radiotherapy, or age at diagnosis influenced the sleepiness scores in patients with craniopharyngioma. CONCLUSION Patients treated for craniopharyngioma or NFMA have increased daytime somnolence despite normal sleep patterns, compared to healthy subjects. The results indicate that increased daytime somnolence is a general consequence of large tumours, and/or their treatment, in the hypothalamic/pituitary region, rather than a specific feature of craniopharyngiomas per se.
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Affiliation(s)
- Agatha A van der Klaauw
- Department of Endocrinology and Metabolic Diseases, Leiden University Medical Center, Leiden, The Netherlands.
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Lee YY, Wong TT, Fang YT, Chang KP, Chen YW, Niu DM. Comparison of hypothalamopituitary axis dysfunction of intrasellar and third ventricular craniopharyngiomas in children. Brain Dev 2008; 30:189-94. [PMID: 17870266 DOI: 10.1016/j.braindev.2007.07.011] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2007] [Revised: 06/22/2007] [Accepted: 07/25/2007] [Indexed: 10/22/2022]
Abstract
In this study, we attempted to determine if different locations of a tumor influence the hypothalamopituitary axis function and outcomes with childhood craniopharyngiomas. The preoperative, postoperative, and long-term follow-up endocrinological disturbances of 66 children with a craniopharyngioma were retrospectively studied. The patients were divided into two subgroups according to the location of the tumor (intrasellar and third ventricle floor). The mean age at onset was 8.02 (range, 1.42-17.58)years. These patients were followed-up for a median duration of 7.2 (range, 2-22)years. Vision problems as the first symptom were more common in Group One (with intrasellar tumors) compared to Group Two (55.6% vs 15.4%; p=0.001; Fisher's exact test). Increased intracranial pressure was the most common initial symptom in patients in Group Two (51.3%) and the second most common symptom in Group One (37%). The majority of patients in both Group One and Group Two required some forms of pituitary hormone supplements (96% vs 84%). At the last follow-up, more patients with intrasellar craniopharyngiomas needed cortisone supplements (79.2% in Group One vs 45.9% in Group Two; p=0.016; Fisher's exact test); however, children with third ventricle floor tumors had more prevalent weight gain (4.2% in Group One vs 27.0% in Group Two; p=0.038; Fisher's exact test). There were different initial presentations and endocrinological outcomes between children with intrasellar and third ventricle floor craniopharyngiomas. The intrasellar tumors had greater pituitary hormone disturbance. However, at the long-term follow-up, children with third ventricle floor tumors had a greater prevalence of being overweight and obese, which was associated with hypothalamic dysfunction.
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Affiliation(s)
- Yi-Yen Lee
- Department of Pediatrics, Taipei City Hospital, Renai Branch, NO.10, Sec. 4, Renai Road, Taipei 106, Taiwan, ROC
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Ragel BT, Bishop FS, Couldwell WT. Recurrent infrasellar clival craniopharyngioma. Acta Neurochir (Wien) 2007; 149:729-30; discussion 730. [PMID: 17533510 DOI: 10.1007/s00701-007-1168-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2006] [Accepted: 04/10/2007] [Indexed: 11/30/2022]
Abstract
The patient is a 44-year-old man who underwent resection of a posterior nasopharynx tumor 12 years earlier via left lateral rhinotomy approach. The final pathological analysis indicated the tumor was a craniopharyngioma, and the patient subsequently underwent focal radiation. The patient returned to medical attention complaining of dysequilibrium. A neurologic exam was nonfocal. Magnetic resonance imaging revealed a clival mass, separate from the sella turcica, with imaging characteristics concerning for chordoma or primary bone tumor (Fig. 1). The lesion was resected via an endoscope-assisted endonasal transsphenoidal approach, with gross total resection achieved. Intraoperatively, the mass was noted to erode through the posterior nasopharynx, without extension superiorly into the sella or posteriorly through the clival dura (i.e., lesion was infrasellar). The final pathological results indicated the tumor was adamantinomatous craniopharyngioma.
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Affiliation(s)
- B T Ragel
- Department of Neurosurgery, University of Utah, Salt Lake City, Utah, USA
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Tena-Suck ML, Salinas-Lara C, Arce-Arellano RI, Rembao-Bojórquez D, Morales-Espinosa D, Sotelo J, Arrieta O. Clinico-pathological and immunohistochemical characteristics associated to recurrence/regrowth of craniopharyngiomas. Clin Neurol Neurosurg 2006; 108:661-9. [PMID: 16500745 DOI: 10.1016/j.clineuro.2006.01.007] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2005] [Revised: 01/04/2006] [Accepted: 01/16/2006] [Indexed: 11/28/2022]
Abstract
BACKGROUND Craniopharyngioma is a rare, benign epithelial brain tumor of the suprasellar region with a high rate of recurrence. Clinical and histopathological features that might be predictors of recurrence/regrowth have not been clearly delineated. METHODS We compared recurrence/regrowth of the tumors with the clinico-pathological characteristics, vascular density, cell proliferation index, and immunohistochemical profile (cytokeratins, epithelial membrane antigen [EMA], carcinoembrionary antigen [CEA], and laminin) of 47 patients with craniopharyngioma followed for more than 5 years. RESULTS Tumors were adamantinomatous in 42 cases (89%) and papillary squamous in 5 cases (11%). Immunoreactivity for cytokeratin 8/18/19 was positive in 64%; cytokeratin 5 in 42%; laminin 8 in 62%; and CEA in 21%. The cell proliferation index and vascular density were greater in adamantinomatous than in papillary tumors (22+/-6 versus 17+/-3, p=0.05; and 21+/-3 versus 17+/-3, p=0.037, respectively); they were neither related to recurrence nor to regrowth. No significant differences were found between adamantinomatous and papillary tumors regarding the presence of cytokeratin, laminin, CEA or glial fibrillary acidic protein (GFAP). Recurrence rate at 5 years was 59%. No relation was found between recurrence and adjuvant radiotherapy (AR). Residual tumor after surgery, whorl-like arrays (p=0.04) and immunoreactivity for p53 (p=0.022) were significantly related to recurrence/regrowth. CONCLUSIONS Residual tumor after surgery, immunoreactivity to p53 and presence of whorl-like arrays are associated to recurrence/regrowth of craniopharyngioma.
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Adler JR, Gibbs IC, Puataweepong P, Chang SD. Visual field preservation after multisession cyberknife radiosurgery for perioptic lesions. Neurosurgery 2006; 59:244-54; discussion 244-54. [PMID: 16883165 DOI: 10.1227/01.neu.0000223512.09115.3e] [Citation(s) in RCA: 150] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE The restricted radiation tolerance of the anterior visual pathways represents a unique challenge for ablating adjacent lesions with single-session radiosurgery. Although preliminary studies have recently demonstrated that multisession radiosurgery for selected perioptic tumors is both safe and effective, the number of patients in these clinical series was modest and the length of follow-up limited. The current retrospective study is intended to help address these shortcomings. METHODS Forty-nine consecutive patients with meningioma (n = 27), pituitary adenoma (n = 19), craniopharyngioma (n = 2), or mixed germ cell tumor (n = 1) situated within 2 mm of a "short segment" of the optic apparatus underwent multisession image-guided radiosurgery at Stanford University Medical Center. Thirty-nine of these patients had previous subtotal surgical resection, and six had previously been treated with conventional fractionated radiotherapy (6). CyberKnife radiosurgery was delivered in two to five sessions to an average tumor volume of 7.7 cm3 and a cumulative average marginal dose of 20.3 Gy. Formal visual testing and clinical examinations were performed before treatment and at follow-up intervals beginning at 6 months. RESULTS After a mean visual field follow-up of 49 months (range, 6-96 mo), vision was unchanged postradiosurgery in 38 patients, improved in eight (16%), and worse in three (6%). In each instance, visual deterioration was accompanied by tumor progression that ultimately resulted in patient death. However, one of these patients, who had a multiply recurrent adrenocorticotropic hormone-secreting pituitary adenoma, initially experienced early visual loss without significant tumor progression after both a previous course of radiotherapy and three separate sessions of radiosurgery. After a mean magnetic resonance imaging follow-up period of 46 months, tumor volume was stable or smaller in all other cases. Two patients died of unrelated nonbrain causes. CONCLUSION Multisession radiosurgery resulted in high rates of tumor control and preservation of visual function in this group of perioptic tumors. Ninety-four percent of patients retained or improved preradiosurgical vision. This intermediate-term experience reinforces the findings from earlier studies that suggested that multisession radiosurgery can be a safe and effective alternative to either surgery or fractionated radiotherapy for selected lesions immediately adjacent to short segments of the optic apparatus.
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Affiliation(s)
- John R Adler
- Department of Neurosurgery, Stanford University Medical School, Stanford, California, USA.
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Frank G, Pasquini E, Doglietto F, Mazzatenta D, Sciarretta V, Farneti G, Calbucci F. The endoscopic extended transsphenoidal approach for craniopharyngiomas. Neurosurgery 2006; 59:ONS75-83; discussion ONS75-83. [PMID: 16888556 DOI: 10.1227/01.neu.0000219897.98238.a3] [Citation(s) in RCA: 68] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE The endoscope has recently been applied to the supradiaphragmatic transsphenoidal approach, but only case reports dealing with different pathological features have been described. The authors present their experience with this technique in 10 patients with craniopharyngiomas. METHODS A pure endoscopic endonasal technique was used. From November 1998 through May 2005, four males and six females with a craniopharyngioma, either purely supradiaphragmatic (six patients) or with a significant suprasellar component (four patients), were treated. The tumors had a mean diameter of 2.9 cm (range, 1-4 cm); four patients had a major prechiasmatic component and six had a retrochiasmatic one. RESULTS Seven total, one subtotal, and two partial resections were obtained. Vision symptoms improved significantly in six out of eight patients. Endocrine function did not improve after surgery, and diabetes insipidus was the most frequent deficit, although it was transient in five out of eight patients. Cerebrospinal fluid leak was the most frequent complication and required reoperation in two patients. Postoperative obesity occurred in two patients. No recurrence has yet been documented in the total resection group. The mean follow-up period is 37 months (range, 3-75 mo). CONCLUSION The endoscopic technique allows results comparable with the best microscopic series. We think that this technique increases the safety of the procedure because of improved vision. Further studies are required to better define the exact location of the tumor with respect to the arachnoidal plane, the extra-arachnoidal craniopharyngioma being the most suitable for a radical removal using a transsphenoidal supradiaphragmatic approach.
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Affiliation(s)
- Giorgio Frank
- Center of Surgery for Pituitary Tumours, Department of Neuroscience, Bellaria Hospital, Bologna, Italy.
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Yamada S, Oyama K. [Craniopharyngioma]. Nihon Rinsho 2006; Suppl 1:183-6. [PMID: 16776122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Affiliation(s)
- Shozo Yamada
- Department of Hypothalamic Pituitary Surgery, Toranomon Hospital
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Musani V, Gorry P, Basta-Juzbasic A, Stipic T, Miklic P, Levanat S. Mutation in exon 7 of PTCH deregulates SHH/PTCH/SMO signaling: possible linkage to WNT. Int J Mol Med 2006; 17:755-9. [PMID: 16596257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/08/2023] Open
Abstract
The novel PTCH mutation and clinical manifestations within Gorlin syndrome family links PTCH haploinsufficiency and aberrant activation of the Wnt pathway. We report a family case with Gorlin syndrome, characterized by the usual phenotype features such as widespread basocellular tumors and craniofacial and bone malformations, but also including a less common appearance of craniopharyngioma. These clinical manifestations might be associated with a novel constitutional mutation of the PTCH gene, 1047insAGAA, which we found in exon 7. It changes the normal amino acid sequence leading to termination of the PTCH protein at exon 9. The analyzed tumors of the family show extensive loss of heterozygosity in the PTCH region, both basocellular and in particular craniopharyngioma, and in the latter a high expression of beta-catenin was detected. Our findings suggest involvement of the SHH/PTCH/SMO pathway in pathogenesis of the analyzed disorders, including its possible contribution to aberrant activation of the Wnt pathway in craniopharyngioma.
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Affiliation(s)
- Vesna Musani
- Division of Molecular Medicine, Rudjer Boskovic Institute, Zagreb, Croatia
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Abstract
In summary, much progress has been made in our understanding of childhood craniopharyngiomas. These histologically benign but "geographically malignant" tumors are challenging to treat and require experienced clinicians from multiple disciplines including neurosurgery, radiology, hematology/oncology, ophthalmology, endocrinology, and general pediatrics to address the multiple issues that arise with diagnosis, treatment, and long-term follow-up of affected children. The study and close observation of patients who have craniopharyngiomas may also be beneficial for our general understanding of pathophysiologic processes such as the observed "growth without growth hormone" phenomenon or the well-described and studied hypothalamic obesity phenotypes.
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Affiliation(s)
- Joshua A May
- Division of Endocrinology, Diabetes, and Metabolism, Childrens Hospital Los Angeles, Keck School of Medicine, University of Southern California, 4650 Sunset Boulevard, MS #61, Los Angeles, CA 90027, USA.
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Nishizawa S, Ohta S, Oki Y. Spontaneous Resolution of Diabetes Insipidus After Pituitary Stalk Sectioning During Surgery for Large Craniopharyngioma-Endocrinological Evaluation and Clinical Implications for Surgical Strategy-. Neurol Med Chir (Tokyo) 2006; 46:126-34; discussion 134-5. [PMID: 16565582 DOI: 10.2176/nmc.46.126] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The mechanism of spontaneous resolution of diabetes insipidus (DI) was investigated after surgery for large craniopharyngioma. Twenty-two adult patients (mean age 48.9 years old), who underwent surgery via the anterior interhemispheric trans-lamina terminalis approach, were divided into three groups: Group I, the entire pituitary stalk was preserved (n = 2); Group II, the stalk was dissected distally from the tumor but ultimately sacrificed (n = 9); Group III, the stalk was not identified and was sacrificed (n = 11). All patients were discharged without neurological deficits 1 month after surgery. Four patients underwent gamma-knife treatment for residual tumor or recurrence. Postoperative endocrinological functions were normal in Group I, and no replacement therapy was required. Hormonal replacement for pan-hypopituitarism and DI was necessary in Groups II and III (mean follow-up period 5.9 years). DI resolved at 2.7 +/- 1.3 years after surgery in four patients in Group II, and a hypertonic saline infusion test revealed production of small amounts of intrinsic antidiuretic hormone (ADH). Urine osmolarity was high in the morning, and a significant increase in urinary osmolarity was noted after Pitressin injection. These results indicate induction of hypersensitivity of the distal renal tubules to small amounts of intrinsic ADH, resulting in decreased urinary output. Recovery from DI can be expected, despite permanent impairment of anterior pituitary function, if the pituitary stalk is dissected as distally as possible.
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Affiliation(s)
- Shigeru Nishizawa
- Department of Neurosurgery, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka.
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Abstract
Central diabetes insipidus developed for the first time in a 14-year-old female during the resection of a craniopharyngioma. The water diuresis persisted until a vasopressin analogue (dDAVP) was given. Professor McCance was asked to explain why hypernatraemia developed, to anticipate dangers that might develop in the salt and water area with therapy, and to provide insights into why this patient died, due to the subsequent development of hyponatraemia that caused a lethal rise in intracranial pressure. The team specifically wanted Professor McCance's opinions as to why a PNa of 124 mmol/l was uniquely dangerous for this patient, and this was a particularly challenging conundrum. Nevertheless, with the aid of a mini-experiment, a careful chart review, and creative thinking, he was able to offer a novel solution, and to suggest ways to prevent its occurrence in other patients.
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Affiliation(s)
- D Bohn
- Department of Critical Care Medicine, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
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Abstract
Craniopharyngiomas are benign suprasellar tumors that arise from epithelial remnants of the Rathke's pouch. The two standard treatment options are primary total resection or limited surgery followed by external beam radiation. The 10- and 20-year progression-free survival rates following limited surgery and radiation therapy are superior to those achieved by primary surgery alone. The side effect profiles for these two treatment approaches are different. Following total resection there is a very high incidence of panhypopituitarism requiring lifelong multiple hormone replacement therapy. The other side effects include potential damage to adjacent structures such as optic chiasm, vasculature and hypothalamus. Following limited surgery and radiation therapy the incidence of endocrine deficits is significantly lower compared to radical surgery, as is the risk of neurovascular and hypothalamic injury. Optic neuropathy and brain necrosis are rare in modern radiation therapy series. Second malignant neoplasms, although rare, can occur. In children with recurrent craniopharyngiomas following radical surgery, the recommended salvage treatment is radiation therapy, as further surgical attempts at salvage are associated with high relapse rates and increased morbidity and mortality. There have been significant technological advances in the field of radiation treatment planning and delivery that have great potential for reducing the incidence of long-term irradiation sequelae in the developing brain. The general availability of megavoltage linear accelerators and modern radiotherapy innovations such as three-dimensional conformal radiation treatment (3D CRT), stereotactic radiosurgery (SRS), stereotactic radiotherapy (SRT), and intensity modulated radiation therapy (IMRT) should further limit the rate of complications and improve cure rates in children with primary or recurrent craniopharyngioma.
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Affiliation(s)
- John A Kalapurakal
- Division of Radiation Oncology, Robert H. Lurie Comprehensive Cancer Center, Children's Memorial Hospital, Northwestern University, Chicago, IL 60611, USA
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Pierre-Kahn A, Recassens C, Pinto G, Thalassinos C, Chokron S, Soubervielle JC, Brauner R, Zerah M, Sainte Rose C. Social and psycho-intellectual outcome following radical removal of craniopharyngiomas in childhood. A prospective series. Childs Nerv Syst 2005; 21:817-24. [PMID: 16049724 DOI: 10.1007/s00381-005-1205-6] [Citation(s) in RCA: 74] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2005] [Indexed: 11/30/2022]
Abstract
BACKGROUND A prospective study on childhood craniopharyngiomas (CPs) was conducted from 1994 to 1998 to appreciate the pre- and postoperative clinical, endocrine, mental, and intellectual status of the patients and to determine the incidence and severity of the postoperative hypothalamic syndrome. METHODS The series included 14 consecutive CPs. Twelve were retrochiasmatic and intraventricular, and two were partly prechiasmatic and extraventricular. All were treated with the aim of "total" removal. The removal was "total" in nine cases but incomplete in the other five. Immediate postoperative follow-up was uncomplicated in all cases. CONCLUSION At 2-year follow-up, the two children with an extraventricular CP and a "total" tumor removal were intellectually normal, had no hypothalamic syndrome, and attended normal school with good results. The 12 others, although still intellectually normal, were more or less severely affected by a hypothalamic syndrome which altered their social insertion and caused academic failure. The authors conclude from this study that radical surgery should be reserved to extraventricular CPs only.
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Affiliation(s)
- A Pierre-Kahn
- Department of Pediatric Neurosurgery, Groupe hospitalier Necker Enfants Malades Paris, 149 rue de Sèvres, 75743, Paris, Cedex 15, France.
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Abstract
RATIONALE Due to the proximity of craniopharyngiomas to the hypothalamus and pituitary gland, most children and adolescents presenting with these tumors will exhibit significant endocrine dysfunction. After treatment, these impairments can become a major cause of morbidity and mortality. METHODS The postoperative course of children undergoing surgery for craniopharyngioma is reviewed. CONCLUSION Even if hormone levels seem to be adequate in the short term after treatment, deficiencies may develop over years and need to be monitored closely.
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Affiliation(s)
- Isil Halac
- Division of Endocrinology, Children's Memorial Hospital, 2300 Children's Plaza, P.O. Box # 54, Chicago, IL 60614, USA
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Abstract
OBJECTIVES In 1996 we published our results for treatment of childhood craniopharyngioma. That study did not only reveal that there was a significant morbidity associated with our then policy of attempted radical removal followed by post-operative radiotherapy in those cases with residual disease, but also that risk factors for poor outcome could be identified based on the clinical and radiological findings at presentation. As result of that study, we redefined the role of radical surgery in the treatment of craniopharyngioma and developed a new treatment strategy in an attempt to improve the quality of outcome without compromising tumour control. Our aims in this paper were to compare the results of our current treatment strategy with that reported in the 1996 paper to assess whether we have achieved this goal. METHODS A detailed assessment of the treatment pathway and outcome was undertaken for children treated for craniopharyngioma in our unit from 1996 to 2004. This included a morbidity score based on visual, motor, cognitive, hypothalamic and endocrinological data obtained from our neuro-oncology database and review of clinical records. Where possible we have attempted to record data in the same manner as for our previous study allowing for meaningful comparison. RESULTS Forty-eight children with craniopharyngioma presented in the study period. On the basis of clinical presentation and radiological findings, 25 were deemed suitable for attempted radical surgery and 23 were treated with various subtotal surgical procedures. Radiotherapy was used in patients over the age of 5 years where residual tumour was present or progressed after the initial surgical intervention(s). Morbidity scores, particularly in relation to visual and cognitive outcome, are improved and there was no surgical mortality in the current series. CONCLUSIONS A treatment paradigm for childhood craniopharyngioma is presented which improves the quality of outcome without compromising tumour control.
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Affiliation(s)
- Dominic Thompson
- Department of Neurosurgery, Great Ormond Street Hospital for Children NHS Trust, London, WC1N 3JH, UK.
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Müller HL, Gebhardt U, Faldum A, Emser A, Etavard-Gorris N, Kolb R, Sörensen N. Functional capacity and body mass index in patients with sellar masses--cross-sectional study on 403 patients diagnosed during childhood and adolescence. Childs Nerv Syst 2005; 21:539-45. [PMID: 15889310 DOI: 10.1007/s00381-005-1166-9] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2005] [Indexed: 11/29/2022]
Abstract
RATIONALE We analyzed the impact of tumour localization and histology on functional capacity (FC) and body mass index (BMI) in children with sellar masses. METHODS FC was evaluated using the ability scale Fertigkeitenskala Münster-Heidelberg in 403 children and adolescents with sellar masses (276 craniopharyngioma, 14 germinoma, 21 optic/chiasmatic glioma, 40 hypothalamic glioma, 13 cysts of Rathke's cleft and 39 other sellar masses). Besides tumour localization, the influence of gender, irradiation and age at diagnosis and at evaluation on FC and BMI was analyzed. General linear models with explanatory influential variables were built. RESULTS In multivariate analysis, only age at diagnosis (p<0.001) and hypothalamic involvement (p=0.005) had relevant impact on FC. The second model showed BMI at diagnosis (p<0,001), hypothalamic involvement (p<0.001) and craniopharyngioma (p=0,004) to influence BMI at the latest evaluation. CONCLUSION We conclude that hypothalamic involvement and young age at diagnosis had major impact on FC and BMI and should be considered as risk factors for impaired rehabilitation.
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Affiliation(s)
- Hermann L Müller
- Department of Paediatrics, Zentrum für Kinder- und Jugendmedizin, Klinikum Oldenburg gGmbH, Germany.
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Kendall-Taylor P, Jönsson PJ, Abs R, Erfurth EM, Koltowska-Häggström M, Price DA, Verhelst J. The clinical, metabolic and endocrine features and the quality of life in adults with childhood-onset craniopharyngioma compared with adult-onset craniopharyngioma. Eur J Endocrinol 2005; 152:557-67. [PMID: 15817911 DOI: 10.1530/eje.1.01877] [Citation(s) in RCA: 80] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Craniopharyngioma is a parasellar tumour that, although benign, tends to behave aggressively. It can occur at any age but most commonly presents in childhood or adolescence. OBJECTIVES To investigate the frequency and severity of problems associated with craniopharyngioma, using the large international database (KIMS) for adult patients with GH deficiency (GHD), and to assess the differences between the adult onset (AO, aged 18 or above) disease and adults with childhood onset (CO) craniopharyngioma. DESIGN Inclusion criteria were: an established diagnosis of craniopharyngioma, severe GHD and no recent GH treatment. These criteria were fulfilled by 393 (184 female, 209 male) patients; 241 had AO (mean age 28.7 +/- 8.7 years) and 152 had CO disease (age 42.0 +/- 12.3 years). Disease history, clinical features and anthropometric data were recorded at the time of enrolment in the database, and body composition, serum IGF-I, serum lipids and quality of life (QoL) were assessed. RESULTS Peak age at onset of craniopharyngioma was 15-20 years. Ninety percent of patients had been treated surgically. CO patients were shorter than AO patients and had much lower IGF-I standard deviation scores (SDS). The majority had hypopituitarism and over 60% had diabetes insipidus. Body mass index (BMI) was higher in AO males (30.2 +/- 5.5) than in CO males (28.5 +/- 7.5); waist circumference was also greater. Obesity was more common in AO patients (51.8% vs 39.1%). Body composition did not differ between groups. Cholesterol and triglycerides were higher in AO than in CO patients, but high density lipoprotein (HDL)- and low density lipoprotein (LDL)-cholesterol did not differ. Quality of life, assessed by Quality of Life-Assessment of Growth Hormone Deficiency in Adults (QoL-AGHDA) and the Nottingham Health Profile, was markedly reduced in all groups with no significant differences between them; the QoL-AGHDA score correlated with age at onset of both craniopharyngioma and GHD, and also with BMI in AO patients. CONCLUSIONS These data emphasise the generally poor state of health of patients treated for craniopharyngioma, with respect to endocrine and metabolic function, and also the markedly reduced quality of life. In addition to GHD, most patients have evidence of hypothalamic damage with associated obesity, diabetes insipidus and hypopituitarism. Adults with CO craniopharyngioma were shorter, had lower IGF-I, lower BMI, less obesity and slightly lower blood lipid levels than patients with AO craniopharyngioma.
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Geffner M, Lundberg M, Koltowska-Häggström M, Abs R, Verhelst J, Erfurth EM, Kendall-Taylor P, Price DA, Jonsson P, Bakker B. Changes in height, weight, and body mass index in children with craniopharyngioma after three years of growth hormone therapy: analysis of KIGS (Pfizer International Growth Database). J Clin Endocrinol Metab 2004; 89:5435-40. [PMID: 15531494 DOI: 10.1210/jc.2004-0667] [Citation(s) in RCA: 73] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Extreme degrees of obesity may occur in association with hypothalamic tumors, usually after surgical intervention. This phenomenon has been reported to occur in as many as 25-75% of children undergoing extensive surgical extirpation of craniopharyngiomas (Cranio). Because less is known about the auxology of children with Cranio with milder alterations in growth, we undertook a 3-yr longitudinal analysis, using the KIGS database (Pfizer International Growth Database), to study their growth patterns and evolution of weight. We compared the effect of GH therapy on height, weight, and body mass index (BMI) in 199 prepubertal children with diagnosed Cranio treated by surgery and/or radiotherapy to two other groups of children with other causes of organic GH deficiency (OGHD): one with postsurgical and/or postirradiated OGHD (OGHD + S/I; n = 92) and the other with OGHD not due to Cranio and not having undergone either surgery or irradiation (OGHD - S/I; n = 85). At the start of GH therapy, 1) mean chronological (P < 0.0001) and bone (P = 0.0002) ages were youngest in OGHD - S/I and oldest in OGHD + S/I; 2) the mean height sd score (SDS) was lowest in OGHD - S/I and comparably higher in the other two groups (P < 0.0001); 3) mean weight and BMI SDS were greatest in Cranio and least in OGHD - S/I (both P < 0.0001); and 4) the mean initial GH dose prescribed was highest in OGHD - S/I and comparable in the other two groups (P < 0.0001). After 3 yr of GH therapy, 1) mean bone age remained youngest in OGHD - S/I and oldest in OGHD + S/I (P < 0.0001); 2) mean height SDS was highest in Cranio and comparably lower in the other two groups (P = 0.0159); 3) mean weight and BMI SDS remained greatest in Cranio and least in OGHD - S/I (P < 0.0001 and P = 0.0003, respectively); and 4) the mean GH dose remained highest in the OGHD - S/I group and least in the Cranio group (P = 0.0082). There were statistically significant increases within each group between the start of treatment and after 3 yr of GH therapy in height and weight, but not in BMI SDS. Lastly, after 3 yr of GH treatment, children in the Cranio group continued to have disproportionately heavier weight and higher BMI (with the greatest values in those with lower stimulated peak GH concentrations) compared with members of the other two groups, with no salutary effect of GH treatment on weight SDS and a mild improvement in BMI SDS. After S/I treatment, children with Cranio are disproportionately prone to varying degrees of weight gain compared with children with other forms of OGHD. In the present cohort of prepubertal children with Cranio, GH therapy induced excellent linear growth, but failed to have an ameliorative effect on weight gain and had only a slight beneficial effect on BMI gain. Because affected children may have resultant significant long-term medical morbidity and diminished quality of life, it is critical that the mechanism of this phenomenon be determined to devise helpful preventive or therapeutic interventions.
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Affiliation(s)
- Mitchell Geffner
- The Saban Research Institute of Childrens Hospital Los Angeles, University of Southern California Keck School of Medicine, Los Angeles, California 90027, USA
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Smith D, Finucane F, Phillips J, Baylis PH, Finucane J, Tormey W, Thompson CJ. Abnormal regulation of thirst and vasopressin secretion following surgery for craniopharyngioma. Clin Endocrinol (Oxf) 2004; 61:273-9. [PMID: 15272926 DOI: 10.1111/j.1365-2265.2004.02086.x] [Citation(s) in RCA: 71] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE In this study we aimed to establish the frequency of postoperative diabetes insipidus and the incidence and characteristics of abnormalities of thirst in a cohort of patients with craniopharyngioma, in whom neurosurgery had been performed. DESIGN Diabetes insipidus was determined by either standard criteria for diagnosis in the immediate postoperative period, or by water deprivation test, in all craniopharyngioma and pituitary tumour patients who underwent surgery in Beaumont Hospital between the years 1986 and 1998. Osmoregulated thirst and vasopressin release were studied during a 2-h infusion of hypertonic (5%) saline followed by a 30-min period of free access to water. PATIENTS Data on the incidence of postoperative diabetes insipidus was collected in 26 patients with craniopharyngioma and 154 patients with pituitary adenomata. We recruited 16 healthy control patients, 16 patients with cranial diabetes insipidus following pituitary tumour surgery and 16 patients with cranial diabetes insipidus following craniopharyngioma resection for the hypertonic saline infusion study. RESULTS Twenty-five patients out of 26 (96%) patients developed diabetes insipidus after surgery for craniopharyngioma, a much higher incidence than after surgery for suprasellar (26/88, 30%, P < 0.001) or intrasellar pituitary tumours (9/66, 14%, P < 0.001). Hypertonic saline infusion identified abnormal thirst responses in five of the 16 craniopharygioma patients studied; all of the pituitary tumour patients had a normal thirst response. Three of the craniopharyngioma patients had adipsic diabetes insipidus whilst two had polydipsic diabetes insipidus. CONCLUSION This study demonstrates following surgery for craniopharyngioma there is a high incidence of cranial diabetes insipidus and a significant incidence of abnormal thirst responses to osmotic stimuli.
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Affiliation(s)
- D Smith
- Academic Department of Endocrinology, Beaumont Hospital, Dublin, Republic of Ireland
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