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Hormonal factors influencing weight and growth pattern in craniopharyngioma
G Pinto1, L Bussières, C Recasens
1Department of Pediatric Endocrinology, Université René-Descartes and Hôpital Necker-Enfants Malades, Paris, France.
Insights
Children with craniopharyngioma experience normal growth despite growth hormone (GH) deficiency due to increased insulin secretion post-surgery. This hormonal shift drives weight gain and maintains insulin-like growth factor levels, explaining preserved statural growth.
Area of Science:
- Pediatric Endocrinology
- Neuroendocrinology
- Metabolic Disorders
Background:
- Craniopharyngioma surgery often leads to hyperphagia, obesity, and growth hormone (GH) deficiency in children.
- Despite GH deficiency, statural growth in these patients is frequently normal, suggesting alternative growth regulatory mechanisms.
Purpose of the Study:
- To evaluate hormonal factors influencing weight and growth changes in children before and after craniopharyngioma resection.
- To investigate the role of insulin secretion and its correlation with body mass index (BMI), insulin-like growth factors (IGF), and leptin levels.
Main Methods:
- Longitudinal study of 17 children undergoing craniopharyngioma resection.
- Hormonal assays (insulin, IGF-I, IGF-II, leptin) and anthropometric measurements (weight, BMI, height) were performed pre- and post-surgery at various time points.
Main Results:
- Pre-operative insulin levels correlated positively with BMI, IGF-I, IGF-II, and leptin.
- Insulin concentrations significantly increased post-surgery, correlating with weight gain and normal growth rates despite complete pituitary deficiency.
- Leptin levels paralleled BMI changes, increasing significantly 3-6 months post-surgery.
Conclusions:
- Craniopharyngioma and its surgical treatment significantly alter insulin secretion control.
- Increased post-operative insulin secretion appears to drive weight gain and maintain near-normal IGF levels, potentially explaining normal growth in the absence of GH.
Abstract:
Patients operated on for craniopharyngioma frequently suffer from hyperphagia and are obese, but their statural growth is normal despite growth hormone (GH) deficiency. We have evaluated the hormonal factors influencing changes in weight and growth in 17 children before and 1, 3-6, 12, and/or 24 months after surgical resection of a craniopharyngioma performed at 7.7 +/- (SE) 1 years of age. Of these, 15 patients had a GH deficiency before surgery, and all had complete pituitary deficiency after it. The plasma fasting insulin concentrations before surgery were positively correlated with body mass index (BMI, kg/m(2); p < 0.05), plasma insulin-like growth factors (IGFI, p = 0.03, and IGFII, p = 0.04), and leptin (p = 0.03). They increased significantly 1 month after surgery and continued to increase thereafter, whereas leptin increased significantly only 3-6 months after surgery, paralleling changes in BMI. The plasma fasting insulin concentrations before surgery were also positively correlated with the weight changes (12.3 +/- 2.3 kg, p < 0.01) during the 12 months after surgery, but not with changes in BMI SDS (3.1 +/- 0.5, p = 0.07). Both expressions of weight change were correlated with the concomitant growth rates (4.8 +/- 0.7 cm, p < 0.01). IGFI was above the 10th percentile for children with idiopathic short stature in 10 of 15 patients with craniopharyngioma-induced GH deficiency and IGF-binding protein 3 in 14 of 15 patients. Craniopharyngioma itself modified the control of insulin secretion, and surgery increased the insulin secretion which continued in the same way in a given patient after surgery. The increased insulin secretion in turn increases weight and keeps IGFI nearly normal. This may explain the normal growth rate despite the complete lack of GH.