title: High prevalence of long-term cardiovascular, neurological and psychosocial morbidity after treatment for craniopharyngioma.
abstract: BACKGROUND
  The treatment of craniopharyngiomas is associated with long-term morbidity.
  
  
  OBJECTIVE
  To assess the long-term functional outcome and mortality rates after treatment for craniopharyngiomas, we audited our data with special focus on cardiovascular, neurological and psychosocial morbidity.
  
  
  METHODS
  Between 1965 and 2002, 54 consecutive patients underwent surgery for craniopharyngiomas at the Leiden University Medical Centre (LUMC). Fifteen patients (25%) received additional postoperative radiation therapy. The median follow-up period was 10 years (range 1-37 years).
  
  
  RESULTS
  Long-term cure rate was 82% and long-term recurrence rate 18%. Visual fields/visual acuity stabilized or improved in 74% of cases. The long-term prevalence rate of hypopituitarism was 89%. In addition, long-term cardiovascular, neurological and psychosocial morbidity rates were high: 22% (risk factors 57%), 49% and 47%, respectively. Female sex was an independent predictor of increased cardiovascular, neurological and psychosocial morbidity (odds ratio 3.78, P = 0.031). Ten patients (18%) died during an 828 person-year follow-up. The actuarial patient survival rates 5, 10 and 20 years after the initial operation were 95, 85 and 85%, respectively. The standardized mortality ratio (SMR) was 2.88 [95% confidence interval (CI) 1.35-4.99].
  
  
  CONCLUSIONS
  Craniopharyngioma is associated with excessive long-term multisystem morbidity and mortality, especially in female patients, despite a high cure rate. These observations indicate that dedicated long-term follow-up of these patients is required. The purpose of the follow-up should be: first, to look for recurrences and to ensure appropriate endocrine replacement, especially oestrogen replacement in premenopausal females; and second, to achieve intensive control of glucose, lipids, blood pressure and weight, as in any other patient with increased risk for cardiovascular disease.
authors.affiliation: Department of Endocrinology and Metabolism, Leiden University Medical Centre, Leiden, The Netherlands. a.m.pereira@lumc.nl
authors.forename: Alberto M
authors.initials: AM
authors.lastname: Pereira
authors.forename: Eva M
authors.initials: EM
authors.lastname: Schmid
authors.forename: Pieter J
authors.initials: PJ
authors.lastname: Schutte
authors.forename: Joan H C
authors.initials: JH
authors.lastname: Voormolen
authors.forename: Nienke R
authors.initials: NR
authors.lastname: Biermasz
authors.forename: Sjoerd W
authors.initials: SW
authors.lastname: van Thiel
authors.forename: Eleonora P M
authors.initials: EP
authors.lastname: Corssmit
authors.forename: Jan W A
authors.initials: JW
authors.lastname: Smit
authors.forename: Ferdinand
authors.initials: F
authors.lastname: Roelfsema
authors.forename: Johannes A
authors.initials: JA
authors.lastname: Romijn
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002318:Cardiovascular Diseases / Q000209:etiology; D002648:Child; D002675:Child, Preschool; D003397:Craniopharyngioma / Q000150:complications / Q000401:mortality / Q000523:psychology / Q000628:therapy*; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009017:Morbidity; D009364:Neoplasm Recurrence, Local; D009422:Nervous System Diseases / Q000209:etiology; D010911:Pituitary Neoplasms / Q000150:complications / Q000401:mortality / Q000523:psychology / Q000628:therapy*; D015995:Prevalence; D012306:Risk; D012737:Sex Factors; D015996:Survival Rate; D013997:Time Factors; D014792:Visual Acuity; D014794:Visual Fields