Endocrine Abstracts

JOINT1608

Introduction: Hypothalamic damage resulting from craniopharyngiomas (CP) and their treatment has been widely associated with hyperinsulinemia, increased appetite due to leptin resistance, and reduced energy expenditure, leading to diminished physical activity. Dysfunction of the hypothalamus, often accompanied by pituitary hormone deficiencies, predisposes up to 50% of affected patients to the development of hypothalamic obesity (HO), typically characterized by rapid and significant weight gain.

Materials and Methods: In May 2020, an 18-year-old female patient S. with a body mass index (BMI) of 25.7 kg/m² underwent stalk CP resection at the N.N. Burdenko National Medical Research Center of Neurosurgery. Postoperatively, she was diagnosed with panhypopituitarism, including central diabetes insipidus, secondary hypocortisolism, hypothyroidism and hypogonadism. Hormone replacement therapy was initiated with desmopressin 0.1 mg three times daily, hydrocortisone 20 mg/day, levothyroxine 100 mg/day, and estradiol gel + dydrogesterone (1/10mg/day). In December 2020, the patient experienced a decline in health, presenting with nausea, vomiting and a decrease in sodium to 105 mmol/l(136-145mmol/L). She was urgently admitted to the intensive care unit, where rapid correction of hyponatremia led to central pontine and extrapontine myelinolysis in the context of panhypopituitarism. The patient developed bilateral supranuclear paresis of the facial, masticatory and bulbar muscles along with tetraplegia. One year later, the patient reported increased appetite and a 19 kg weight gain. Metformin therapy (1000mg/day) was prescribed. In 2022, during hospitalization at the Endocrinology Research Centre, insulin resistance was confirmed (HOMA index: 2.82), and her BMI had increased to 33.9 kg/m². She was referred to a dietitian, who recommended a hypocaloric diet and increased physical activity. In November 2023, clinical and laboratory tests confirmed pharmacological compensation of panhypopituitarism. MRI showed no signs of CP recurrence. However, the patient experienced nocturnal awakenings to eat, leading to a diagnosis of eating disorder (ED) with pansyndromal overeating. Psychoanaleptics were added to the regimen, but weight gain continued (BMI: 35.9kg/m²).

Results: This case underscores the complexities in managing HO, where despite the optimization of hormone replacement therapy, caloric restriction, increased physical activity, and pharmacological control of the ED, the patient was unable to achieve a normal body weight.

Conclusions: The identification of etiological factors contributing to HO, along with the development of novel or combined therapeutic strategies, could provide a multifaceted approach to managing hyperphagia, insulin resistance, hypopituitarism and psychosocial rehabilitation. Such interventions may lead to more effective and sustainable weight loss outcomes and help minimize the risk of long-term complications.