title: Tumor origin and growth pattern at diagnosis and surgical hypothalamic damage predict obesity in pediatric craniopharyngioma.
abstract: Severe obesity is a major problem in pediatric craniopharyngioma. We investigated whether tumor origin, growth pattern, and surgical damage predict obesity in pediatric craniopharyngioma. Subjects were 58 patients (30 males) with no tumor recurrence during the first postoperative 18 months. Preoperative hypothalamic involvement was classified into no (pre_G0, n = 19), little (pre_G1, n = 21), and severe (pre_G2, n = 18) involvement groups based on sub- or supradiaphragmatic tumor origin and growth patterns. Postoperative hypothalamic involvement was classified into no (post_G0, n = 4), minimal (post_G1, n = 19), and significant (post_G2, n = 35) involvement groups according to follow-up imaging. The prevalence of obesity increased from 13.2 % at diagnosis (mean age = 8.1 years) to 37.9 % at last follow-up (mean duration = 9.1 years). Only the body mass index (BMI) Z-score increment of the first postoperative year (first-year ΔBMI_Z) was significant (P = 0.007). Both the preoperative BMI_Z (P = 0.001) and the first-year ΔBMI_Z (P = 0.017) showed an increasing trend from the pre_G0 to pre_G1 to pre_G2 group. For the 40 patients with pre_G0 or pre_G1, the first-year ΔBMI_Z was higher in the post_G2 group than the post_G1 group (0.02 ± 0.91 vs. 0.89 ± 0.72, P = 0.003). Tumor origin and growth pattern affect preoperative BMI_Z and postoperative weight gain. Despite little or no hypothalamic involvement at diagnosis, surgical damage contributes to postoperative weight gain in patients with craniopharyngioma.
authors.affiliation: Division of Endocrinology and Metabolism, Department of Pediatrics, Seoul National University Children's Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 110-769, South Korea.
authors.forename: Seung Wan
authors.initials: SW
authors.lastname: Park
authors.forename: Hae Woon
authors.initials: HW
authors.lastname: Jung
authors.forename: Young Ah
authors.initials: YA
authors.lastname: Lee
authors.forename: Choong Ho
authors.initials: CH
authors.lastname: Shin
authors.forename: Sei Won
authors.initials: SW
authors.lastname: Yang
authors.forename: Jung-Eun
authors.initials: JE
authors.lastname: Cheon
authors.forename: In-One
authors.initials: IO
authors.lastname: Kim
authors.forename: Ji Hoon
authors.initials: JH
authors.lastname: Phi
authors.forename: Seung-Ki
authors.initials: SK
authors.lastname: Kim
authors.forename: Kyu-Chang
authors.initials: KC
authors.lastname: Wang
mesh_terms: D015992:Body Mass Index; D002648:Child; D003397:Craniopharyngioma / Q000150:complications* / Q000175:diagnosis / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007029:Hypothalamic Neoplasms / Q000150:complications* / Q000175:diagnosis / Q000601:surgery; D008297:Male; D060787:Neoplasm Grading; D009765:Obesity / Q000175:diagnosis* / Q000209:etiology; D010911:Pituitary Neoplasms / Q000150:complications* / Q000175:diagnosis / Q000601:surgery; D011183:Postoperative Complications; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D015430:Weight Gain