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Endocrine function, morbidity, and mortality after surgery for craniopharyngioma
Insights
Childhood craniopharyngioma treatment frequently causes pituitary deficits, including hormone deficiencies and diabetes insipidus. These deficits pose significant long-term risks and can lead to medical emergencies and mortality.
Area of Science:
- Pediatric Endocrinology
- Pediatric Neurosurgery
- Oncology
Background:
- Craniopharyngioma is a common pediatric brain tumor affecting the pituitary gland.
- Treatment of craniopharyngioma often leads to significant endocrine dysfunction.
Purpose of the Study:
- To assess the incidence and long-term consequences of pituitary deficits following craniopharyngioma treatment in children.
- To evaluate the mortality associated with these endocrine deficits.
Main Methods:
- Retrospective review of medical records for 59 children treated for craniopharyngioma between 1960 and 1980.
- Analysis of postoperative endocrine deficiencies and mortality data.
Main Results:
- High rates of postoperative deficiencies were observed: growth hormone (100%), andrenocorticotropic hormone (72%), thyrotropin (65%), gonadotropin (94%), and diabetes insipidus (76%).
- Fifteen patients died, with diabetes insipidus contributing to early deaths and anterior pituitary insufficiency suspected in later unexpected deaths.
- Hypopituitarism caused medical emergencies in 12 patients, including symptomatic hypoglycemia in 9.
Conclusions:
- Current craniopharyngioma treatment methods result in a high incidence of pituitary deficits in children.
- These deficits present substantial long-term risks, including increased mortality and medical emergencies.
Abstract:
The records of 59 children with craniopharyngioma first treated between 1960 and 1980 were reviewed. There was a high incidence of postoperative growth hormone deficiency (43 of 43), andrenocorticortopin deficiency (26 of 36), thyrotrophin deficiency (13 of 20), gonadotrophin deficiency (15 of 16), and diabetes insipidus (44 of 58). Fifteen patients have died: diabetes insipidus was a contributory factor in 5 patients who died within the first 4 months of surgery; and 8 further children died unexpectedly after the postoperative period, probably as a result of anterior pituitary insufficiency. In addition, hypopituitarism led to medical emergencies in 12, 9 of whom had symptomatic hypoglycaemia. These findings illustrate the high incidence of pituitary deficits which follow current methods for treating childhood craniopharyngioma, and the long-term risks associated with these deficits.