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Clinical Research

Detailed assessment of hypothalamic damage in craniopharyngioma patients with obesity

International Journal of Obesity volume 43, pages 533–544 (2019)Cite this article

Subjects

Abstract

Background/objectives

Hypothalamic obesity (HO) occurs in 50% of patients with the pituitary tumor craniopharyngioma (CP). Attempts have been made to predict the risk of HO based on hypothalamic (HT) damage on magnetic resonance imaging (MRI), but none have included volumetry. We performed qualitative and quantitative volumetric analyses of HT damage. The results were explored in relation to feeding related peptides and body fat.

Subjects/methods

A cross-sectional study of childhood onset CPs involving 3 Tesla MRI, was performed at median 22 years after first operation; 41 CPs, median age 35 (range: 17–56), of whom 23 had HT damage, were compared to 32 controls. After exclusions, 35 patients and 31 controls remained in the MRI study. Main outcome measures were the relation of metabolic parameters to HT volume and qualitative analyses of HT damage.

Results

Metabolic parameters scored persistently very high in vascular risk particularly among HT damaged patients. Patients had smaller HT volumes compared to controls 769 (35–1168) mm3 vs. 879 (775–1086) mm3; P < 0.001. HT volume correlated negatively with fat mass and leptin among CP patients (rs = −0.67; P < .001; rs = −0.53; P = 0.001), and explained 39% of the variation in fat mass. For every 100 mm3 increase in HT volume fat mass decreased by 2.7 kg (95% CI: 1.5–3.9; P < 0.001). Qualitative assessments revealed HT damage in three out of six patients with normal volumetry, but HT damage according to operation records.

Conclusions

A decrease in HT volume was associated with an increase in fat mass and leptin. We present a method with a high inter-rater reliability (0.94) that can be applied by nonradiologists for the assessment of HT damage. The method may be valuable in the risk assessment of diseases involving the HT.

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Acknowledgments

This work was supported by the Swedish Children's Cancer Foundation, the Swedish Cancer Foundation, and the Medical Faculty, Lund University, Sweden

Author information

Author notes

  1. These authors contributed equally: Follin C., Gabery S.

Authors and Affiliations

  1. Department of Endocrinology, Skåne University Hospital, Lund, Sweden

    S. Fjalldal, C. Follin, A. Pålsson & E. M. Erfurth

  2. Translational Neuroendocrine Research Unit, Department of Experimental Medical Science, Lund University, Lund, Sweden

    S. Gabery, R. Cheong & Å. Petersén

  3. Department of Medical Imaging and Physiology, Skåne University Hospital, Lund, Sweden

    P. C. Sundgren, I. M. Björkman-Burtscher, J. Lätt & P. Mannfolk

  4. Department of Diagnostic Radiology, Clinical Sciences, Lund University, Lund, Sweden

    P. C. Sundgren & I. M. Björkman-Burtscher

  5. Lund University BioImaging Center, Lund University, Lund, Sweden

    I. M. Björkman-Burtscher

  6. Department of Neurosurgery, Skåne University Hospital, Lund, Sweden

    C. H. Nordström

  7. Division of Occupational and Environmental Medicine, Lund University, Lund, Sweden

    L. Rylander

  8. Department of Endocrinology and Medical and Health Sciences, Linköping University, Linköping, Sweden

    B. Ekman

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Correspondence to E. M. Erfurth.

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Conflict of interest

Eva Marie Erfurth received lecture fees from Pfizer and Eli Lilly, B.E. received lecture fees from Novartis and has received fees for consultancy from Pfizer and Shire, all other authors have nothing to disclose.

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Fjalldal, S., Follin, C., Gabery, S. et al. Detailed assessment of hypothalamic damage in craniopharyngioma patients with obesity. Int J Obes 43, 533–544 (2019). https://doi.org/10.1038/s41366-018-0185-z

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