title: GLP-1 analogues as a new treatment option for hypothalamic obesity in adults: report of nine cases.
abstract: BACKGROUND
  Patients with hypothalamic pathology often develop morbid obesity, causing severe metabolic alterations resulting in increased morbidity and mortality. Glucagon-like peptide-1 (GLP-1) analogues improve glycaemic control in type 2 diabetic patients and cause weight loss in obese patients by yet unknown mechanisms. Here we tested whether GLP-1 analogues were also effective in the treatment of obesity and associated metabolic alterations in patients with hypothalamic disease.
  
  
  METHODS
  Nine patients (eight with type 2 diabetes mellitus) with moderate to severe hypothalamic obesity were treated with GLP-1 analogues for up to 51 months. Body weight, homeostasis model assessment - insulin resistance (HOMA-IR), HbA1c and lipids were assessed.
  
  
  RESULTS
  Eight patients experienced substantial weight loss (-13.1±5.1 kg (range -9 to -22)). Insulin resistance (HOMA-IR -3.2±3.5 (range -9.1 to 0.8)) and HbA1c values (-1.3±1.4% (range -4.5 to 0.0)) improved under treatment (24.3±18.9 months (range 6 to 51)). Five patients reported increased satiation in response to the treatment. Two of the eight patients complained about nausea and vomiting and one of them abandoned therapy because of sustained gastrointestinal discomfort after 6 months. One patient suffered from intolerable nausea and vomiting and discontinued treatment within 2 weeks.
  
  
  CONCLUSIONS
  GLP-1 analogues can cause substantial and sustained weight loss in obese patients with hypothalamic disease. This offers a new approach for medical treatment of moderate to severe hypothalamic obesity and associated metabolic alterations.
authors: Division of Endocrinology and Diabetes, Department of Medicine 1, Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany.
authors: Flavius
authors: F
authors: Zoicas
authors: Michael
authors: M
authors: Droste
authors: Bernhard
authors: B
authors: Mayr
authors: Michael
authors: M
authors: Buchfelder
authors: Christof
authors: C
authors: Schöfl
mesh_terms: D000293:Adolescent; D000328:Adult; D001786:Blood Glucose; D003397:Craniopharyngioma / Q000150:complications / Q000188:drug therapy / Q000503:physiopathology; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy* / Q000209:etiology / Q000503:physiopathology; D000077270:Exenatide; D052216:Glucagon-Like Peptide 1 / Q000031:analogs & derivatives* / Q000627:therapeutic use; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D007027:Hypothalamic Diseases / Q000150:complications / Q000188:drug therapy* / Q000503:physiopathology; D007333:Insulin Resistance; D000069450:Liraglutide; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000150:complications / Q000188:drug therapy* / Q000503:physiopathology; D010455:Peptides / Q000627:therapeutic use*; D010911:Pituitary Neoplasms / Q000150:complications / Q000188:drug therapy / Q000503:physiopathology; D014688:Venoms / Q000627:therapeutic use*
chemical_list: D001786:Blood Glucose; D007004:Hypoglycemic Agents; D010455:Peptides; D014688:Venoms; D000069450:Liraglutide; D052216:Glucagon-Like Peptide 1; D000077270:Exenatide