title: Risk factors for mortality caused by hypothalamic obesity in children with hypothalamic tumours.
abstract: Hypothalamic obesity (HyOb) is a common complication of childhood hypothalamic tumours. Patients with HyOb probably have a higher mortality rate than those with other types of obesity due in many cases to obstructive sleep apnoea/hypoventilation.
  
  
  
  To identify predictive factors for mortality caused by HyOb in children.
  
  
  
  Twenty children with HyOb secondary to hypothalamic tumours that were followed-up for ≥3 years and aged <15 years at diagnosis, and received supraphysiological glucocorticoid treatment for ≤1 month.
  
  
  
  Mean age at diagnosis was 6.36 ± 3.60 years. Mean body mass index (BMI) Standard deviation of the samples (SDS) increased from 0.77 ± 1.26 to 2.66 ± 1.45 during the first 6 months, but slowed from month 6-12 (2.73 ± 1.35). ΔBMI SDS at 0-6 months was significantly higher in patients aged <6 years at diagnosis than in those aged >6 years at diagnosis (3.71 ± 1.96 vs. 0.83 ± 0.73, P < 0.001). Maximum BMI SDS was also significantly higher in the younger group (3.88 ± 1.39 vs. 2.79 ± 0.64, P < 0.05). In all, four patients died and the mortality rate was significantly higher in the patients with a further increase in BMI SDS > 1 SDS after 6 months of therapy (RR: 8.4, P < 0.05). Both overall mortality and obesity-related mortality rates were higher in the patients aged <6 years at diagnosis (4.5-fold, 7.2-fold higher, respectively, P > 0.05). The mortality rate was also 3.7-fold higher in the patients with a maximum BMI SDS ≥ 3 at any time during the first 3 years after therapy(P > 0.05).
  
  
  
  An increase in BMI SDS after 6 months of therapy was observed to be a risk factor for mortality caused by HyOb. In addition, age <6 years at diagnosis and a maximum BMI SDS ≥ 3 were associated with a higher mortality rate, indicating that earlier and more aggressive treatment of obesity is required.
authors.affiliation: Department of Pediatric Endocrinology, Marmara University Medical School, Istanbul, Turkey. belmahaliloglu26@hotmail.com.
authors.forename: B
authors.initials: B
authors.lastname: Haliloglu
authors.affiliation: Department of Pediatric Endocrinology, Marmara University Medical School, Istanbul, Turkey.
authors.forename: Z
authors.initials: Z
authors.lastname: Atay
authors.affiliation: Department of Pediatric Endocrinology, Marmara University Medical School, Istanbul, Turkey.
authors.forename: T
authors.initials: T
authors.lastname: Guran
authors.affiliation: Department of Pediatric Endocrinology, Marmara University Medical School, Istanbul, Turkey.
authors.forename: S
authors.initials: S
authors.lastname: Abalı
authors.affiliation: Department of Pediatric Endocrinology, Marmara University Medical School, Istanbul, Turkey.
authors.forename: S
authors.initials: S
authors.lastname: Bas
authors.affiliation: Department of Pediatric Endocrinology, Marmara University Medical School, Istanbul, Turkey.
authors.forename: S
authors.initials: S
authors.lastname: Turan
authors.affiliation: Department of Pediatric Endocrinology, Marmara University Medical School, Istanbul, Turkey.
authors.forename: A
authors.initials: A
authors.lastname: Bereket
mesh_terms: D000293:Adolescent; D015992:Body Mass Index; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007029:Hypothalamic Neoplasms / Q000150:complications* / Q000401:mortality; D007031:Hypothalamus / Q000503:physiopathology*; D007223:Infant; D008297:Male; D009765:Obesity / Q000175:diagnosis / Q000209:etiology* / Q000401:mortality; D012189:Retrospective Studies; D012307:Risk Factors
keywords: Brain tumour; craniopharyngioma; mortality