J Korean Neurosurg Soc.  2022 May;65(3):439-448. 10.3340/jkns.2021.0067.

Determinants of Short-Term Weight Gain Following Surgical Treatment for Craniopharyngioma in Adults

• Hong AR
• Kim JH
• Park SS
• Kong SH
• Choi HJ
• Kim YH
• Shin CS

• KMID: 2529589
• DOI: http://doi.org/10.3340/jkns.2021.0067

Abstract

Objective
: Craniopharyngiomas (CPs) are associated with hypothalamic damage that causes hypothalamic obesity, however, the mechanisms underlying CP-related postoperative weight gain remain debatable. This study aimed to elucidate whether the major determinant of postoperative weight gain in patients with CP is hypothalamic injury or steroid replacement therapy.
Methods
: We included 48 adult patients with CP (age ≥18 years) who underwent transsphenoidal surgery between 2010 and 2018 in a single tertiary center, and whose body weight was measured pre- and postoperatively (<120 days after the surgery). We recruited 144 age- and body mass index-matched patients with non-functioning pituitary adenoma (NFPA) as controls.
Results
: Patients with CP experienced greater postoperative weight gain than patients with NFPA (3.0±5.1 vs. 0.1±3.6 kg, p<0.001). The prevalence of postoperative steroid use was significantly higher in patients with CP than in those with NFPA (89.6% vs. 34.0%, p<0.001). Steroid replacement therapy and CP were associated with postoperative weight gain after adjusting for covariates in overall patients (p=0.032 and 0.007, respectively). In subgroup analysis with postoperative steroid users, weight gain was significantly greater in patients with CP (n=43, 0.96±0.25 kg/month) than in patients with NFPA (n=49, 0.26±0.23 kg/month) even after adjusting for the daily steroid dose (p=0.048).
Conclusion
: Patients with CP experience greater postoperative weight gain than those with NFPA. Hypothalamic damage itself as well as steroid replacement may contribute to the postoperative weight gain in patients with CP.

Keyword

Craniopharyngioma; Pituitary adenoma; Obesity; Surgery; Steroid

Figure

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  Fig. 1. Flow diagram of the study subjects. CP : craniopharyngioma, NFPA : non-functioning pituitary adenoma, post-op : post-operative, BMI : body mass index.

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  Fig. 2. Box and whisker plot of weight change per month in all subjects according to the (A) steroid replacement therapy after adjusting for age, sex, body mass index (BMI), and disease type and (B) disease type after adjusting for age, sex, BMI, and steroid replacement therapy. Data are expressed as median (range). *p<0.05. CP : craniopharyngioma, NFPA : non-functioning pituitary adenoma.

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  Fig. 3. Box and whisker plot of weight change per month only in steroid users according to the (A) daily steroid dose after adjusting for age, sex, body mass index (BMI), and disease type and (B) disease type after adjusting for age, sex, BMI, and daily steroid dose. Data are expressed as median (range). *p<0.05. CP : craniopharyngioma, NFPA : non-functioning pituitary adenoma.

Reference

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