Factors associated with acquired hypothalamic obesity in children with hypothalamic tumors: a comparative...

Acquired hypothalamic obesity is a complex condition resulting from hypothalamic damage, often due to tumors. However, not all children with hypothalamic masses develop obesity; while hypothalamic involvement is a recognised factor, the impact of specific surgical approaches and concurrent endocrine deficits on diverse tumour cohorts requires further elucidation. To evaluate clinical, radiological, surgical, and endocrine factors associated with obesity in children with hypothalamic tumors.

This retrospective single-center study included 34 pediatric patients with hypothalamic tumors (median age at diagnosis: 6.0 years; IQR: 6) followed between 1999 and 2020. Patients with conditions or medications causing obesity were excluded. Data on tumor characteristics, treatment modalities, surgical approach, and endocrine abnormalities were collected. Obesity was defined as BMI > +2 SDS, and patients were grouped as obese and non-obese for comparative analysis.

The most frequent tumor types were optic glioma, pilocytic astrocytoma, and craniopharyngioma. Obesity developed in 15 patients (44.1%). The median time to obesity onset was 3.00 months (IQR: 12.50) after diagnosis, with no significant difference in total follow-up duration between obese and non-obese groups (3.00 vs 3.50 years, p=0.471). At diagnosis, the groups differed significantly regarding surgical history, particularly pterional craniotomy (p=0.048), and the presence of adrenal insufficiency (p=0.020) or hypogonadism (p=0.004). However, univariable logistic regression showed that surgical method was not significantly associated with obesity. Obesity was also significantly associated with insulin resistance (p=0.010) and dyslipidemia (p=0.019).

In conclusion, hypothalamic obesity develops rapidly in children with hypothalamic tumors, often within the first few months following diagnosis. While surgical intervention-particularly via pterional craniotomy-showed a significant association with obesity in bivariate analysis, this association was not statistically significant in univariable logistic regression. The presence of obesity is closely linked to metabolic disturbances such as insulin resistance and dyslipidemia, as well as adrenal insufficiency and hypogonadism. These findings emphasize the necessity of early metabolic screening and personalized follow-up strategies immediately after diagnosis for this high-risk population.