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Features of the Metabolic Syndrome after Childhood Craniopharyngioma

Institute of Endocrinology and Diabetes (S.S., G.D.O., S.P.G., J.W.L., C.T.C.) and Department of Nuclear Medicine (J.N.B.), The Children’s Hospital at Westmead, Westmead, New South Wales 2145, Australia

Address all correspondence and requests for reprints to: Dr. Shubha Srinivasan, Institute of Endocrinology and Diabetes, The Children’s Hospital at Westmead, Locked Bag 4001, Westmead, New South Wales 2145, Australia. E-mail: shubhas{at}chw.edu.au.

Obesity and multiple pituitary hormone deficiency are common complications after surgery for childhood craniopharyngioma. We hypothesized that post craniopharyngioma surgery, children are at high risk for the metabolic syndrome, including insulin resistance due to excess weight gain and GH deficiency. This study characterized body composition (anthropometry and dual energy x-ray absorptiometry) and metabolic outcomes in 15 children (10 males and 5 females; age, 12.2 yr; range, 7.2–18.5 yr) after surgical removal of craniopharyngioma. In 9 subjects, outcomes were compared with those of healthy age-, sex-, body mass index-, and pubertal stage-matched controls. Insulin sensitivity was measured by 40-min iv glucose tolerance test. Seventy-three percent of subjects were overweight or obese. Sixty-six percent had normal growth velocity without GH treatment. Subjects had increased abdominal adiposity (P = 0.008) compared with controls. However, there was no significant difference in total body fat. Subjects had higher fasting triglycerides (P = 0.02) and lower high density lipoprotein cholesterol to total cholesterol ratio (P = 0.015). Insulin sensitivity was equally reduced for subjects and controls (P = 0.86). After craniopharyngioma removal, patients had more features of the metabolic syndrome compared with controls. This could be a result of hypothalamic damage causing obesity and GH deficiency. Further studies exploring predictors of the metabolic syndrome after craniopharyngioma surgery are required.

This work was supported by a Research Fellowship (to G.D.O.) that was supported by Pharmacia.

Abbreviations: BMI, Body mass index; DXA, dual energy x-ray absorptiometry; FFA, free fatty acid; GHD, GH deficiency; HDL, high density lipoprotein; IVGTT, iv glucose tolerance test; k_g, glucose disappearance rate; LDL, low density lipoprotein; Si, insulin sensitivity; TG, triglycerides.

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