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Gastric bypass surgery for treatment of hypothalamic obesity after craniopharyngioma therapy

Nature Clinical Practice Endocrinology & Metabolism volume 3, pages 606–609 (2007)Cite this article

Abstract

Background A 14-year-old boy presented with daytime somnolence, intermittent emesis and hypothyroidism. Neuroimaging revealed a calcified suprasellar intracranial mass, suspected to be a craniopharyngioma. Subtotal resection of the tumor confirmed the diagnosis. Extreme obesity (BMI >60 kg/m2) and hyperinsulinemia followed tumor resection and cranial irradiation. Dietary interventions were unsuccessful, and pharmacologic intervention (i.e. octreotide) only slowed the rate of weight gain.

Investigations Radiography documented the suprasellar mass. Following surgical resection and radiotherapy, hypothalamic–pituitary deficiencies were found. Preprandial and postprandial excursions of insulin, active ghrelin and leptin were measured before and after gastric bypass surgery.

Diagnosis Panhypopituitarism, hypothalamic obesity and hyperinsulinemia following craniopharyngioma therapy.

Management Severe caloric restriction, octreotide, and pituitary hormone replacement did not produce weight loss. Gastric bypass surgery led to reduced food cravings, significant weight loss, and amelioration of obesity-related comorbidities. Correction of fasting hyperinsulinemia, normalization of postprandial insulin responses, and reductions in active ghrelin and leptin concentrations were also observed.

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Figure 1: MRI scan of the patient's brain before craniotomy; posterior view (A) and lateral view (B)
Figure 2: BMI changes of the patient and clinical events over time

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Acknowledgements

Written consent for publication was obtained from the patient's responsible relative.The authors would like to express gratitude for the helpful scientific input of R Lustig, R Seeley, J Kral, M Vierra, and D D'Alessio. In addition, we appreciate the expert clinical care provided by V Garcia, S Kirk, S Xanthakos, H Roehrig, and J Sweeney.This work was supported in part by an NIH General Clinical Research Center grant #M01 RR 08084 including Clinical Research Feasibility Funding (CReFF) funding to MZ.

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Authors and Affiliations

  1. Division of Pediatric Surgery, Division of Pediatric Endocrinology and M Zeller is an Associate Professor, Division of Behavioral Medicine, Department of Psychiatry, TH Inge is an Associate Professor, SR Rose is a Professor, all at Cincinnati Children's Hospital. P Pfluger is a Fellow, and MH Tschöp is an Associate Professor, University of Cincinnati, Cincinnati, OH, USA.,

    Thomas H Inge, Paul Pfluger, Meg Zeller, Susan R Rose & Matthias H Tschöp

  2. L Burget is a resident at the Kantonsspital Luzern, Switzerland ,

    Lukas Burget

  3. S Sundararajan is a Clinical Assistant Professor at Rainbow Babies and Children's Hospital, Cleveland, OH ,

    Sumana Sundararajan

  4. SR Daniels is a Professor and Chairman of the Department of Pediatrics, University of Colorado at Denver and Health Sciences Center, CO, USA.,

    Stephen R Daniels

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  1. Thomas H Inge
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Correspondence to Thomas H Inge.

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The authors declare no competing financial interests.

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Inge, T., Pfluger, P., Zeller, M. et al. Gastric bypass surgery for treatment of hypothalamic obesity after craniopharyngioma therapy. Nat Rev Endocrinol 3, 606–609 (2007). https://doi.org/10.1038/ncpendmet0579

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