Ann Pediatr Endocrinol Metab.  2018 Mar;23(1):51-55. 10.6065/apem.2018.23.1.51.

Hepatopulmonary syndrome caused by hypothalamic obesity and nonalcoholic fatty liver disease after surgery for craniopharyngioma: a case report

Affiliations
  • 1Department of Pediatrics, Asan Medical Center Children's Hospital, University of Ulsan College of Medicine, Seoul, Korea. hwyoo@amc.seoul.kr

Abstract

Hypothalamic obesity is often complicated in patients with craniopharyngioma due to hypothalamic damage by the tumor itself, treatment modalities, and associated multiple pituitary hormone deficiency. Hypothalamic obesity causes secondary diseases such as nonalcoholic fatty liver disease (NAFLD) and diabetes mellitus (DM). We report a 19-year-old female who was diagnosed with craniopharyngioma, developed hypothalamic obesity after tumor resection, and progressed to hepatopulmonary syndrome. She manifested NAFLD 1 year after tumor resection. Two years later, the craniopharyngioma recurred, and she underwent a second resection. Three years after her second operation, she was diagnosed with type 2 DM, after which she did not visit the outpatient clinic for 2 years and then suddenly reappeared with a weight loss of 25.8 kg that had occurred over 21 months. One month later, she presented to the Emergency Department with dyspnea. Laboratory findings revealed liver dysfunction and hypoxia with increased alveolar artery oxygen gradient. Liver biopsy showed portal hypertension and micronodular cirrhosis. Echocardiography and a lung perfusion scan demonstrated a right to left shunt. She was finally diagnosed with hepatopulmonary syndrome and is currently awaiting a donor for liver transplantation. Patients surviving craniopharyngioma need to be followed up carefully to detect signs of hypothalamic obesity and monitored for the development of other comorbidities such as DM, NAFLD, and hepatopulmonary syndrome.

Keyword

Craniopharyngioma; Hepatopulmonary syndrome; Hypothalamus; Nonalcoholic fatty liver disease; Obesity

MeSH Terms

Ambulatory Care Facilities
Anoxia
Arteries
Biopsy
Comorbidity
Craniopharyngioma*
Diabetes Mellitus
Dyspnea
Echocardiography
Emergency Service, Hospital
Female
Fibrosis
Hepatopulmonary Syndrome*
Humans
Hypertension, Portal
Hypothalamus
Liver
Liver Diseases
Liver Transplantation
Lung
Non-alcoholic Fatty Liver Disease*
Obesity*
Oxygen
Perfusion
Tissue Donors
Weight Loss
Young Adult
Oxygen

Figure

  • Fig. 1. The patient’s growth curve during the follow-up period. The patient was diagnosed with craniopharyngioma and underwent tumor resection at the age of 11.2 years (plain arrow). However, the craniopharyngioma recurred and a second resection was performed at the age of 13.3 years (thick arrow). Hepatopulmonary syndrome occurred at the age of 18.9 years (dashed arrow).

  • Fig. 2. Transmission electron microscopic image of a liver specimen. Pathological findings demonstrate micronodular cirrhosis with an increase in glycogen and cytoplasmic fat globules (arrow) (×2,500).

  • Fig. 3. Lung perfusion scan shows diffusely increased activity in the brain, kidneys, and spleen, indicating a right to left shunt.


Reference

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