Failure of GLP-1 Agonist Therapy to Improve Weight in a 3-Year-Old Patient With Tumor-Related Obesity

A 19-month-old female patient presented due to rapid weight gain starting at age 5 months. Due to continued abnormal weight gain after 1 year of age, an MRI of the brain was performed, revealing a 5.5 × 2.6 × 2.3 cm mass centered within the medulla oblongata with extension to the C3 vertebral body. Biopsy confirmed a diagnosis of ganglioglioma. A trial of topiramate was attempted, but there was no improvement in weight gain after 2 months. The patient started on 0.3 mg liraglutide daily, and the dose was titrated up to 3 mg daily over 3 months. The patient did not experience abdominal pain, nausea, vomiting, or diarrhea. Weight continued to increase at a drastic rate, and increased appetite persisted. Liraglutide was discontinued. Liraglutide may be safe for use in children as young as age 3 years. However, its effect on weight loss in cases of hypothalamic obesity may be limited. The medulla oblongata contains GLP-1 receptors and is involved in the suppression of food intake. In the presented case, lack of response to treatment was likely due to medullary damage from the tumor. Further research about the etiology of neurogenic causes of obesity is needed so targeted therapies may be developed.