Adiposity trajectories and predictors of obesity in patients with childhood-onset craniopharyngioma

Byungsun Yoo; Kim Joo Whan; Lee Yun Jeong; Jeesun Yoo; Yongbeom Cho; Uisook Song; Kim Yong Hwy; Phi Ji Hoon; Seung-Ki Kim; Shin Choong Ho; Lee Young Ah

doi:10.1530/endoabs.110.EP1074

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Endocrine Abstracts (2025) 110 EP1074 | DOI: 10.1530/endoabs.110.EP1074

ECEESPE2025 ePoster Presentations Pituitary, Neuroendocrinology and Puberty (220 abstracts)

Adiposity trajectories and predictors of obesity in patients with childhood-onset craniopharyngioma

Byungsun Yoo ¹ , Joo Whan Kim ² , Yun Jeong Lee ¹ , Jeesun Yoo ¹ , Yongbeom Cho ¹ , Uisook Song ¹ , Yong Hwy Kim ² , Ji Hoon Phi ² , Seung-Ki Kim ² , Choong Ho Shin ¹ & Young Ah Lee ¹

Author affiliations

¹Seoul National University Children’s Hospital, Seoul National University College of Medicine, Department of Pediatrics, Seoul, South Korea; ²Seoul National University Children’s Hospital, Seoul National University College of Medicine, Department of Neurosurgery, Seoul, South Korea

JOINT2100

Objective: Hypothalamic obesity may affect long-term quality of life in patients with craniopharyngioma (CRP). We investigated factors influencing body mass index (BMI) z-scores and overweight or obesity(OWOB) over a 5-year postoperative follow-up in childhood-onset CRP patients.

Methods: We retrospectively reviewed 110 CRP patients (65 males), who underwent surgery (median age 8.0 years) between June 1998 and June 2019 with at least 5 years of follow-up without recurrence. Age at surgery, 2 kinds of hypothalamic involvement (HI) [Puget grade 0-1 vs. 2 (n = 68) and SNUH grade (29 anterior, 39 middle, 41 posterior)], surgical approach, timing of growth hormone (GH) initiation (within 3 year and 3+ years), and intensive lifestyle education (before or after year 2014) were included as factors affecting BMI z-scores over a 5-year period or OWOB at 5 years postoperatively.

Results: Significant changes were found in BMI z-scores and the rates of OWOB from the time of surgery (34.2%), to 1, 2, 3, and 5 postoperative years (48.2%, 43.7%, 39.1%, and 36.3%, respectively). In OWOB group at the time of surgery, BMI z-scores decreased significantly over a 5-year period (P <0.001). In a linear mixed model, significant difference was found in BMI trajectory over a 5-year period between age groups at surgery (below or above 8.0 years of age) and between HI groups (P <0.001 for all). BMI z-scores over a 5-year period are greater in higher HI compared to lower HI group [Puget grade (2 vs. 0-1, P <0.01) and SNUH grade (posterior vs. anterior and middle, P <0.01)]. No significant differences were observed based on surgical approach, timing of GH initiation, or lifestyle education interventions. When multivariate-adjusted model was constructed including age at diagnosis, initial BMI category and each HI grade, not only age at surgery and initial OWOB (both P <0.01) but also Puget grade (P = 0.001) and SNUH grade (P = 0.007) were significant factors for OWOB at 5 years postoperatively.

Conclusions: While HI was common in childhood-onset CRP patients, with one third of patients classified as OWOB at diagnosis, the rates of OWOB increased until the first postoperative year and then showed a decreasing trend over a 5-year period. Age at diagnosis, initial BMI category, and high HI grade were independent predictors for postoperative 5 year OWOB. Children who are older (≥ 8.0 years of age), severely damaged hypothalamus, and obese at diagnosis are at high risk of being obese 5 years after surgery.