Obesity, metabolic syndrome, and insulin dynamics in children after craniopharyngioma surgery.
BACKGROUND
Children after craniopharyngioma surgery often develop rapid weight gain and hyperphagia. We investigate the metabolic syndrome features, risk factors, and the insulin dynamics in these patients.


METHODS
Standard oral glucose tolerance tests (OGTT) were performed in 12 subjects, aged 7.7-18.1 years, after surgical removal of craniopharyngioma and their healthy age-, sex-, body mass index-, and pubertal stage-matched controls. Blood samples were obtained for measurement of levels of plasma glucose, insulin, lipids, liver enzymes, baseline hormonal profiles with calculation of insulin secretion, and insulin sensitivity indices derived from OGTT.


CONCLUSIONS
Nine of 12 subjects were severely obese. All patients exhibited significant weight gain after surgery. The waist to hip ratio was higher in subjects compared to controls (P = 0.023). Subjects had higher fasting triglycerides (P = 0.019) and lower HDL/total cholesterol ratio (P = 0.012). Five of 12 subjects met the criteria for the metabolic syndrome, compared with one of 12 in controls. One patient had prediabetes and another patient had overt type 2 diabetes. Six of 12 subjects had nonalcoholic steatohepatitis. No significant risk factors were found between each group of patients with and without the metabolic syndrome. There were no differences of insulin secretion and insulin sensitivity indices between craniopharyngioma and control subjects.


CONCLUSIONS
Children after craniopharyngioma surgery are at risk of rapid weight gain and the development of metabolic syndrome. Further studies to better understand the mechanism are required to design effective treatment and prevention.
Division of Pediatric Endocrinology, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, 10330, Thailand. Taninee.P@chula.ac.th
Taninee
T
Sahakitrungruang
Tippayakarn
T
Klomchan
Vichit
V
Supornsilchai
Suttipong
S
Wacharasindhu
D000293:Adolescent; D001786:Blood Glucose / Q000378:metabolism; D015992:Body Mass Index; D016022:Case-Control Studies; D002648:Child; D003397:Craniopharyngioma / Q000097:blood / Q000150:complications* / Q000601:surgery*; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000209:etiology; D005234:Fatty Liver / Q000097:blood / Q000209:etiology; D005260:Female; D005951:Glucose Tolerance Test; D006801:Humans; D006963:Hyperphagia / Q000097:blood / Q000209:etiology; D007328:Insulin / Q000378:metabolism*; D008297:Male; D024821:Metabolic Syndrome / Q000097:blood / Q000209:etiology*; D009765:Obesity / Q000097:blood / Q000209:etiology*; D012307:Risk Factors; D014280:Triglycerides / Q000097:blood; D049629:Waist-Hip Ratio; D015430:Weight Gain
D001786:Blood Glucose; D007328:Insulin; D014280:Triglycerides