Patients with craniopharyngiomas: therapeutical difficulties with growth hormone

Craniopharyngioma (CP) is a rare and benign tumor of the pituitary region. It is the second cause of hypopituitarism in children and the third in adults. Multiple pituitary deficiencies or panhypopituitarism and diabetes insipidus are very frequent and their prevalence increases significantly after neurosurgery. In patients with GH deficiency (GHD), recombinant GH (rGH) replacement is recommended, after a near complete surgical excision of CP and exclusion of tumor progression. The risk of CP recurrence or progression due to rGH therapy is unproven. Treatment with rGH improves significantly the quality of life (QoL), although body composition and lipid abnormalities are not modified. At the data lock 2003, in the Hypopituitary Control and Complications Study (HypoCCS) Italian Database 90 patients with CP were included. Adulthood onset (AO) hypopituitarism had been diagnosed in two/thirds of them. They had worse QoL than their childhood onset (CO)-counterpart. During 3-yr rGH treatment mean body mass index, fat mass percentage, and both hip and waist circumferences decreased significantly only in CO patients. Accordingly, total cholesterol and triglycerides decreased, and HDL-cholesterol increased significantly in CO- but not in AO-patients. Analysis of dose titration showed that CO- were treated with higher rGH doses than AO-patients.