Hypothalamic obesity in adults with craniopharyngiomas: prevalence and risk factors before and after neurosurgical treatment

Hypothalamic obesity (weight gain due to hypothalamic damage) is a common complication of surgical treatment of craniopharyngiomas. Data on the prevalence and clinical features of hypothalamic obesity in adults with craniopharyngiomas are scarce, and reports on prognostic factors are contradictory.

OBJECTIVE

To assess the prevalence and risk factors of hypothalamic obesity before and after neurosurgical treatment of craniopharyngiomas in adults.

MATERIAL AND METHODS

This prospective study included 99 adults with craniopharyngioma. A comprehensive examination was performed. Damage to hypothalamic-pituitary structures was assessed using preoperative MRI, clinical, laboratory and intraoperative data.

RESULTS

Pre- and postoperative hypothalamic obesity was detected in 32 (32%) and 47 (57.3%) patients, respectively. Hypothalamic obesity was significantly more common in pituitary stalk and ventricular craniopharyngiomas compared to endosuprasellar craniopharyngiomas (p<0.05). Fifty-nine (71%) patients experienced significant (≥5%) body weight gain after surgery (median 15% [8.8; 24.0] or 11 kg [7; 17]). Analysis of groups with and without hypothalamic obesity after surgery revealed significant differences in baseline body mass index (30.8 kg/m² [27.0; 35.9] and 22.1 kg/m² [19.4; 25.2], respectively, p<0.001), incidence of mental disorders (36.2% and 14.3%, respectively, p=0.027) and preoperative hypogonadism (93.5% and 71.4%, respectively, p=0.013). In multivariate analysis, independent risk factors of hypothalamic obesity were preoperative body mass index with a cutoff value of 27 kg/m² and third ventricular bottom lesions due to tumor infiltration. No effect of histological type of craniopharyngioma, surgical approach or extent of surgery on the incidence of hypothalamic obesity was found.

CONCLUSION

There was high incidence of hypothalamic obesity due to tumor growth and surgical treatment in adults with craniopharyngioma. Predictors of hypothalamic obesity after surgery for craniopharyngioma were baseline body mass index and damage to third ventricle bottom.