Endocrine Abstracts

Hypothalamic obesity (HO) is usually caused by hypothalamic damage from treatment of sellar/suprasellar tumours. Therapeutic options have been limited. Emerging evidence on the efficacy of new generation glucagon-like peptide-1 receptor agonists or dual agonist (GLP1RAs) is promising. We report our experience of GLP1RAs in patients with HO. 15 patients were offered GLP1RAs but only 13 were included in this retrospective analysis (two excluded due to medication non-adherence and side effect requiring cessation). Of 13 patients (M:F=7:6), over 60% were established on at least four pituitary hormonal replacements and 11 out of 13 patients had type 2 diabetes. GLP1RAs used were: Mounjaro®(6), Rybelsus®(5), Ozempic®(1) and Trulicity®(1). Doses were uptitrated based on tolerability and patient preference. Data is expressed as median(range). Paired student’s t-test was used for statistical analyses between continuous variables. At start of GLP1RAs, median age was 44(17-67) years and BMI 44(27-70) kg/m². Over a median follow-up of 18(6-40) months, baseline weight, BMI and HbA1c dropped by 22(6-67) kg, 7(2-29) kg/m² and 16(1-70) mmol/mol respectively (P < 0.05). Most patients were on less than maximal licensed dose of Mounjaro® or equivalent dose of Ozempic®. There was a 17(8-41) % weight loss from baseline (P < 0.05). For the eight patients with medium-term data beyond 12 months, a plateau in weight loss was observed. Unfasted untimed total serum cholesterol, non-HDL cholesterol and triglycerides dropped by 23(2-47) % from 5.1(3.7-9.2) mmol/l, 38(3-66) % from 4.1(2.9-8.2) mmol/l and 39(50-78) % from 2.7(1.1-8.1) mmol/l respectively (P < 0.05). There was no significant change serum HDL cholesterol. GLPRAs at submaximal doses induce durable clinically significant weight loss in patients with HO and offers a promising treatment strategy.