Insulin sensitivity and secretion in children and adolescents with hypothalamic obesity following treatment for craniopharyngioma.
BACKGROUND
Craniopharyngioma (CP), a tumour occurring in the hypothalamic-pituitary area, results in morbid obesity in 25-60% of affected children. It has been suggested that abnormalities of insulin secretion and/or insulin action due to hypothalamic injury may be associated with weight gain and the metabolic syndrome in this population.


OBJECTIVE
To evaluate: (i) insulin secretion (IS) and insulin sensitivity (Si); (ii) features of the metabolic syndrome (MS) and (iii) factors involved in risk for diabetes and heart disease in obese youth treated for CP.


METHODS
Obese subjects treated for CP were compared to BMI-matched control subjects. All subjects underwent anthropometric, blood pressure, resting energy expenditure and body fat assessment. Cholesterol and inflammatory markers, oral glucose tolerance test (OGTT) and frequent sampling intravenous glucose tolerance test (FSIGT), with calculation of IS and Si, were performed.


RESULTS
Fifteen CP subjects and 15 controls (C) were studied. There were no differences between CP and C for age, gender, BMI or pubertal status. MS was present in 10/15 CP and 3/15 C (P = 0.03), including impaired glucose tolerance (IGT) in 6/15 CP and 0/15 C (P = 0.02). Measures of IS, including first and second phase IS, and insulin area-under-the-curve (AUC(ins)) during OGTT, were significantly higher in CP. Si, measured by frequent sampled intravenous glucose tolerance test (Si-FSIGT), was significantly lower in CP subjects (0.96 +/- 0.34 vs. 1.67 +/- 0.7; P = 0.01). AUC(ins) was negatively correlated with Si-FSIGT (r = -0.62; P = 0.003).


CONCLUSIONS
Children with CP and hypothalamic obesity have more features of MS, increased IS and IGT prevalence and lower Si compared with BMI-matched controls.
Simoneau-Roy
Judith
J
Division of Endocrinology, The Hospital for Sick Children, and University of Toronto, Toronto, ON, Canada.
O'Gorman
Clodagh
C
Pencharz
Paul
P
Adeli
Khosrow
K
Daneman
Denis
D
Hamilton
Jill
J
D000293:Adolescent; D016022:Case-Control Studies; D002648:Child; D003397:Craniopharyngioma / Q000601:surgery*; D050171:Dyslipidemias / Q000150:complications; D005260:Female; D005951:Glucose Tolerance Test; D006801:Humans; D006973:Hypertension / Q000150:complications; D007031:Hypothalamus / Q000293:injuries; D007328:Insulin / Q000378:metabolism; D007333:Insulin Resistance; D000078790:Insulin Secretion; D008297:Male; D009765:Obesity / Q000150:complications / Q000378:metabolism / Q000503:physiopathology*; D010911:Pituitary Neoplasms / Q000601:surgery*; D011183:Postoperative Complications / Q000209:etiology / Q000378:metabolism / Q000503:physiopathology*; D055815:Young Adult
D007328:Insulin