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Children with craniopharyngioma. Early growth failure and rapid postoperative weight gain
1Children's Hospital, University of Helsinki, Finland.
Insights
Children with craniopharyngioma often experience growth failure before diagnosis and significant weight gain after surgery. Early growth monitoring is crucial for timely diagnosis and improved outcomes in pediatric patients.
Area of Science:
- Pediatric Endocrinology
- Pediatric Oncology
- Pediatric Neurosurgery
Background:
- Craniopharyngioma frequently causes growth failure in children, often preceding diagnosis by several years.
- Preoperative obesity is observed in a subset of pediatric patients diagnosed with craniopharyngioma.
- Postoperative weight gain and obesity are significant concerns following craniopharyngioma treatment.
Purpose of the Study:
- To analyze pre- and postoperative growth patterns in children treated for craniopharyngioma.
- To investigate the incidence of obesity and its relationship with tumor characteristics and surgical approach.
- To assess hormonal profiles, specifically insulin and insulin-like growth factor I (IGF-I), in relation to growth and weight status post-surgery.
Main Methods:
- Retrospective analysis of growth data in 22 children with craniopharyngioma.
- Monitoring of relative weight changes during the first three postoperative months and one year after surgery.
- Assessment of serum insulin and IGF-I levels in children with growth hormone deficiency (GHD) post-surgery.
- Evaluation of final height standard deviation scores (SDS) with and without growth hormone (GH) substitution.
Main Results:
- Growth failure preceded diagnosis in 19 out of 22 children.
- Significant weight gain occurred postoperatively, with 14/21 children experiencing >10% relative weight increase within 3 months, and 13/21 becoming obese by one year.
- Obesity development was not directly linked to tumor size or surgical method.
- Hormonal analysis in GHD patients revealed associations between obesity, supranormal insulin, and subnormal IGF-I levels.
- Final height SDS was suboptimal in many patients, with GH substitution improving outcomes in some.
Conclusions:
- Craniopharyngioma significantly impacts pediatric growth, necessitating vigilant monitoring.
- Postoperative weight management and hormonal balance are critical in the long-term care of these children.
- Early and consistent growth assessment is vital for timely diagnosis and potentially better therapeutic outcomes in pediatric craniopharyngioma patients.
Abstract:
Pre- and postoperative growth was analyzed in 22 children with craniopharyngioma. In 19 children a growth failure preceded the diagnosis by a mean of 4 years. Six children were obese preoperatively. During the first 3 postoperative months relative weight increased greater than 10% in 14/21 children (there was one surgical death). One year after surgery 13/21 were obese. Neither the size of the tumor nor the mode of surgery was decisive in the development of the obesity. Serum insulin and insulin-like growth factor I (IGF-I) were assessed in four children with growth hormone deficiency (GHD) who, after surgery for craniopharyngioma, were growing normally without GH substitution. One of them was normal in weight and had normal insulin and IGF-I levels; the others were obese and had supranormal insulin and subnormal IGF-I levels. One of the four and two other children with unsubstituted GHD reached final height SDS -0.8, -2.0 and -2.4. One child with normal postoperative GH response reached final height SDS -0.7. Final height SDS greater than or equal to -2.5 was gained with GH substitution by 6/11 children. It was greater than 2.0 SD below the height SDS expected from the heights of the parents in 7/11. An adequate monitoring of children's growth would lead to earlier diagnosis and probably better outcome.