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Longitudinal Study on Growth and Body Mass Index before and after Diagnosis of Childhood Craniopharyngioma

Department of Pediatrics, Zentrum für Kinder- und Jugendmedizin, Klinikum Oldenburg GmbH (H.L.M., G.B., N.E.-G., U.G., R.O., R.K.), Oldenburg, Germany; Institute for Medical Biostatistics, Epidemiology and Informatics, University of Mainz (A.E., A.F.), Mainz, Germany; and Department of Pediatric Neurosurgery, University Hospital (N.S.), Wurzburg, Germany

Address all correspondence and requests for reprints to: Hermann L. Müller, M.D., Department of Pediatrics, Zentrum für Kinder- und Jugendmedizin, Klinikum Oldenburg GmbH, Dr. Eden Strasse 10, 26133 Oldenburg, Germany. E-mail: mueller.hermann{at}klinikum-oldenburg.de.

We analyzed whether childhood craniopharyngioma predisposes to obesity and growth impairment. Height/length, body mass index (BMI), and hypothalamic involvement were evaluated in 90 patients at standardized ages and time points before, after, and at the time of diagnosis. Relevant decreases in height SD score (SDS) started at 10–12 months of age and persisted until diagnosis of childhood craniopharyngioma. Relevant increases in BMI SDS were detectable between 4 and 5 yr of age. Postoperative BMI SDS (yr 1–6) had a weak positive correlation with BMI SDS at the time of diagnosis. In linear regression analysis, hypothalamic tumor involvement (P < 0.001), ponderal index at birth (P = 0.014), and BMI SDS at age 6–7 months (P = 0.029) and at age 5 yr (P < 0.001) had relevant and independent impacts on the development of obesity. Patients with hypothalamic involvement (n = 48) presented lower ponderal index and BMI SDS at birth and higher BMI SDS at the time of diagnosis (P < 0.001) as well as during annual follow-up (P < 0.001) compared with patients without hypothalamic involvement (n = 42). From childhood (3.5–4 yr) to the time of diagnosis, growth rates were reduced for patients with hypothalamic tumor involvement. Patients without hypothalamic involvement presented reduced growth rates in early infancy (age 10–12 months) that persisted until diagnosis. We conclude that reduced growth rates occur quite early in history; BMI SDS increases occur later and are predictive of obesity. Hypothalamic involvement is the major risk factor for obesity in patients with childhood craniopharyngioma.

This work was supported by Deutsche Kinderkrebsstiftung (Bonn, Germany; www.kinderkrebsstiftung.de) Grant DKS 2001.04.

Results of this study were presented in part at the 85th Annual Meeting of The Endocrine Society, Philadelphia, Pennsylvania, 2003.

Abbreviations: BMI, Body mass index; CI, confidence interval; IUGR, intrauterine growth retardation; PI, ponderal index; SDS, SD score.

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