Gastric bypass surgery for treatment of hypothalamic obesity after craniopharyngioma therapy.
BACKGROUND
A 14-year-old boy presented with daytime somnolence, intermittent emesis and hypothyroidism. Neuroimaging revealed a calcified suprasellar intracranial mass, suspected to be a craniopharyngioma. Subtotal resection of the tumor confirmed the diagnosis. Extreme obesity (BMI >60 kg/m(2)) and hyperinsulinemia followed tumor resection and cranial irradiation. Dietary interventions were unsuccessful, and pharmacologic intervention (i.e. octreotide) only slowed the rate of weight gain.


METHODS
Radiography documented the suprasellar mass. Following surgical resection and radiotherapy, hypothalamic-pituitary deficiencies were found. Preprandial and postprandial excursions of insulin, active ghrelin and leptin were measured before and after gastric bypass surgery.


METHODS
Panhypopituitarism, hypothalamic obesity and hyperinsulinemia following craniopharyngioma therapy.


RESULTS
Severe caloric restriction, octreotide, and pituitary hormone replacement did not produce weight loss. Gastric bypass surgery led to reduced food cravings, significant weight loss, and amelioration of obesity-related comorbidities. Correction of fasting hyperinsulinemia, normalization of postprandial insulin responses, and reductions in active ghrelin and leptin concentrations were also observed.
Inge
Thomas H
TH
Division of Pediatric General and Thoracic Surgery, ML 2023, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229-3039, USA. thomas.inge@cchmc.org
Pfluger
Paul
P
Zeller
Meg
M
Rose
Susan R
SR
Burget
Lukas
L
Sundararajan
Sumana
S
Daniels
Stephen R
SR
Tschöp
Matthias H
MH
D000293:Adolescent; D003131:Combined Modality Therapy / Q000009:adverse effects; D003397:Craniopharyngioma / Q000628:therapy*; D015390:Gastric Bypass / Q000379:methods*; D006801:Humans; D006946:Hyperinsulinism / Q000209:etiology / Q000503:physiopathology; D007018:Hypopituitarism / Q000209:etiology / Q000503:physiopathology; D007027:Hypothalamic Diseases / Q000150:complications* / Q000209:etiology; D008297:Male; D009765:Obesity / Q000209:etiology* / Q000503:physiopathology / Q000601:surgery*; D010911:Pituitary Neoplasms / Q000628:therapy*