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The endocrine outcome after surgical removal of craniopharyngiomas
J Curtis1, D Daneman, H J Hoffman
1Division of Endocrinology, Hospital for Sick Children, Toronto, Ont., Canada.
Insights
Children with craniopharyngioma often present with short stature and require extensive hormone replacement therapy after surgery. Postoperative obesity is common, but growth hormone may offer improvement.
Area of Science:
- Pediatric Endocrinology
- Pediatric Neurosurgery
- Oncology
Background:
- Craniopharyngioma is a common pediatric brain tumor often associated with hormonal dysfunction.
- Surgical resection is the primary treatment, but frequently leads to significant postoperative complications.
Purpose of the Study:
- To review the postoperative course and long-term endocrine sequelae in children treated for craniopharyngioma.
- To evaluate the incidence of hormone deficiencies and the need for replacement therapies.
Main Methods:
- Retrospective review of pediatric patients who underwent surgical resection for craniopharyngioma.
- Analysis of endocrine function, growth parameters, and body mass index in the postoperative period.
Main Results:
- Most patients required multiple hormone replacement therapies, including corticosteroids, thyroid hormone, and sex steroids.
- Diabetes insipidus was a frequent complication, often permanent.
- Growth hormone deficiency was observed in 54%, with some patients experiencing continued growth despite it.
- Postoperative obesity affected 50% of patients, with potential benefits from growth hormone therapy.
Conclusions:
- Surgical resection of craniopharyngioma in children results in significant and often permanent endocrine deficits.
- Comprehensive and lifelong hormone replacement is crucial for managing these patients.
- Further research, including controlled trials, is needed to optimize management of growth and obesity post-surgery.
Abstract:
The postoperative course of children undergoing surgery for craniopharyngioma was reviewed. Typically they were below height at presentation. All had an attempt at radical surgical resection of the tumor. Most developed diabetes insipidus in the postoperative period, which was permanent in all but 1 child. 94% required thyroid replacement therapy, and sex steroids were administered in 100% when they reached the age of puberty. 91% required maintenance corticosteroids. 54% required growth hormone replacement, but some children showed continued growth despite apparent growth hormone deficiency. Postoperative obesity develops in one half of patients, and may be improved with administration of growth hormone; a controlled trial is underway.