Endocrine Abstracts

When a craniopharyngioma (CP) causes hypothalamus (HT) damage this will result in hypothalamic obesity (HO), cognitive dysfunction and increased stroke mortality. Suggested treatment when the HT is affected by a CP is subtotal resection and in some cases followed by cranial radiotherapy (CRT). In the preoperative phase, a multidisciplinary team may suggest HT sparing surgery with subtotal tumour removal. If in spite of all efforts the HT is damaged, there will be an immediate increase in hunger craving resulting in a devastating weight increase. The strongest increase in weight is within the first 12 mo and the proposal is that neurally mediated high insulin is the primary factor in the development of HO. Within weeks, an MRI gives information of the extent of HT damage and also of the remaining HT volume. The HT volume may give the cardiovascular prognosis. Immediate efforts of dieticians and cardiovascular drugs with GLP-1 agonist, and central stimulating drugs need to be administered. Later in the follow up diffusion tensor imaging (DTI), a noninvasive technique of the white matter of the brain, may predict cognitive dysfunction. White matter lesions (WML), seen on T2 MRI, are pathological changes caused by obstruction of small cerebral vessels resulting in hypo-perfusion and are predictive of stroke. CP patients, who have a reduced HT volume and were treated with CRT have increased WML volume. Assessment of HT volume, DTI, WML should be considered in the postoperative phase and follow up care of patients with CP as this may create an opportunity for early preventive treatment of cognitive dysfunction, CV disease and stroke risk. These different assessments can also be used in a broader perspective for all tumours that involves the HT.