title: Hypothalamic obesity: prevalence, associations and longitudinal trends in weight in a specialist adult neuroendocrine clinic.
abstract: OBJECTIVE
  Obesity is highly prevalent among adults with acquired, structural hypothalamic damage. We aimed to determine hormonal and neuroanatomical variables associated with weight gain and obesity in patients following hypothalamic damage and to evaluate the impact of early instigation of weight loss measures to prevent or limit the severity of obesity in these patients.
  
  
  METHODS
  Retrospective study of 110 adults with hypothalamic tumours attending a specialist neuroendocrine clinic. BMI was calculated at diagnosis and at last follow-up clinic visit. Endocrine data, procedures, treatments and weight loss measures were recorded and all available brain imaging reviewed.
  
  
  RESULTS
  At last follow-up, 82.7% of patients were overweight or heavier (BMI≥25 kg/m(2)), 57.2% were obese (BMI≥30 kg/m(2)) and 14.5% were morbidly obese (BMI≥40 kg/m(2)). Multivariate analysis revealed that use of desmopressin (odds ratio (OR)=3.5; P=0.026), GH (OR=2.7; P=0.031) and thyroxine (OR=3.0; P=0.03) was associated with development of new or worsened obesity. Neuroimaging features were not associated with weight gain. Despite proactive treatments offered in clinic in recent years (counselling, dietetic and physical activity advice, and anti-obesity medications), patients have continued to gain weight.
  
  
  CONCLUSIONS
  Despite increased awareness, hypothalamic obesity is difficult to prevent and to treat. Improved understanding of the underlying pathophysiologies and multicentre collaboration to examine efficacy of novel obesity interventions are warranted.
authors.affiliation: Department of Obesity and Endocrinology, University of Liverpool, Liverpool, UK.
authors.forename: Caroline A
authors.initials: CA
authors.lastname: Steele
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Cuthbertson
authors.forename: Ian A
authors.initials: IA
authors.lastname: MacFarlane
authors.forename: Mohsen
authors.initials: M
authors.lastname: Javadpour
authors.forename: Kumar S V
authors.initials: KS
authors.lastname: Das
authors.forename: Catherine
authors.initials: C
authors.lastname: Gilkes
authors.forename: John P
authors.initials: JP
authors.lastname: Wilding
authors.forename: Christina
authors.initials: C
authors.lastname: Daousi
mesh_terms: D000328:Adult; D000368:Aged; D015331:Cohort Studies; D004700:Endocrine System Diseases / Q000453:epidemiology / Q000503:physiopathology / Q000628:therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007027:Hypothalamic Diseases / Q000453:epidemiology* / Q000503:physiopathology* / Q000628:therapy; D008137:Longitudinal Studies; D008297:Male; D008511:Medicine / Q000639:trends; D008875:Middle Aged; D009765:Obesity / Q000453:epidemiology* / Q000503:physiopathology* / Q000628:therapy; D010044:Outpatient Clinics, Hospital / Q000639:trends*; D015995:Prevalence; D012189:Retrospective Studies; D015430:Weight Gain / Q000502:physiology*