Endocrine Abstracts

Background: Patients being cured of craniopharyngioma (CP) often suffer from severe hypothalamic obesity due to tumor localization or therapeutic interventions, which has a major impact on increased mortality and reduced quality of life. Gastric bypass surgery (GBS) was suggested to be an effective therapeutic option for weight reduction in those patients. However, long-term changes in body weight and postsurgical complications are unknown.

Methods: 5 patients with severe hypothalamic obesity being cured of CP, who underwent GBS, were included in a retrospective analysis (age: 20.8 ± 4.4 years BMI: 47.3 ± 7.7 kg/m²). They were compared to a control group of patients with common obesity who underwent GBS, matched for preoperative age and BMI (age: 23.1 ± 3.7 years BMI: 48.7 ± 6.3 kg/m²).

Results: Gastric bypass surgery led to a distinct weight loss after 1.5 ± 1.1 years in both groups (CP: –44.0 kg ± 19.4, controls: –43.8 kg ± 14.1; P = 0.176). However, in long term follow-up (6.1 ± 2.9 years) weight regain was observed in 3 of 5 CP patients, 1 CP patient suffered from severe postsurgical malnutrition, whereas only 1 CP patient had a favorable long-term outcome comparable to controls (BMI at long-term follow-up: 42.2 kg/m² ± 10.5 vs 31.2 kg/m² ± 6.3). Postoperative complications requiring in-patient treatment were significantly more often in CP (CP: 4/5 (80%), controls: 5/24 (20%), P = 0.022).

Conclusions: Despite promising results of weight reduction in the first years following GBS, long-term outcome is worse in patients suffering from hypothalamic obesity. Weight regain is more likely and the rate of severe postsurgical complications is higher in patients with CP compared to controls.