Change in Endocrine Function after Treatment of Craniopharyngioma

Lim, J S; Kim, S Y; Yu, J S; Shin, C H; Yang, S W

Abstract

PURPOSE
Craniopharyngioma is intracranial tumor that arises from theremnants of Rathke's pouch. Because of its location near pituitary glands and hypothalamus, many patients show endocrine dysfunction before and after surgical removal of tumor. In this retrospective study, the authers observed the frequency of hypopituitarism and developement of growth failure and obesity.
METHODS
A total 24 children who were diagnosed as craniopharyngioma and operated in SNUCH between October, 1984 and May, 1995 were included in this study. Their medical records of clinical symptoms and their preoperative thyroid function test(TFT) and postoperative pituitary function test were reviewed. After surgery, we followed their height and weight and calculate growth velocity, height SDS, and BMI before GH replacement.
RESULTS
The study included each 12 male and 12 female children and their mean age was 7 year and 5 months. After surgical removal, 35% were recurred. The common presenting symptoms were headache in 88%, visual disturbance in 79%, vomiting in 76% and poor growth in 29%. Only 26% complained of nocturia or polyuria. TFT were abnormal in 2 patients(9%). After surgical removal of tumor, diabetes insipidus appeared in 23 of 24 (96%) patients and during DDAVP replacement, 3 patients recovered after 7 months of operation. In postoperative pituitary functinon test, GH deficiency were found in 96%, and cortisone deficiency in 70%, TRH deficiency in 81%, LH in 63%, and FSH in 74%. Their growth velocity was 5.76cm/year during the 1st year after surgery, 6.03cm/year during the 2nd year. But decreased to 3.45cm/year during the 3rd year. Height SDS was -0.93 before surgery, -0.86 at 1st year after surgery, -0.92 at 2nd year, but decreased to -1.59 at 3rd year. Before surgery patients average BMI was 15.0+/-1.7. It increased to 20.0+/-3.8 in postoperative 1st year. It showed also stastically significant correlation with growth velocity change during the 1st year.
CONCLUSIONS
After surgical removal of craniopharyngioma, it is important to manage endocrine sequaele because of most patients had multiple pituitary hormone deficiency. The obesity seems to be responsible for the normal growth velocity during the first two years after treatment for craniopharyngioma without the effect of growth hormone deficiency. The effect of growth hormone deficiency seems to be prominent after 2nd year of treatment. So we recommand GH replacement should start in the 3rd year.