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- Erfurth, Eva Marie
(författare)
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Obesity and metabolic disturbances in adamantinomatous craniopharyngioma patients
- 2017
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Ingår i: Basic Research and Clinical Aspects of Adamantinomatous Craniopharyngioma. - Cham : Springer International Publishing. - 9783319518886 - 9783319518909 ; , s. 85-99
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Bokkapitel (refereegranskat)abstract
- An adamantinous craniopharyngioma (CP) is rare benign pituitary tumour often growing invasively and thereby affecting the hypothalamus. The recurrence rate in CP is high and therapy of choice is surgery, followed by cranial radiotherapy (CRT) in about half of the patients. Patients with CP have a 3-19 fold higher cardiovascular mortality in comparison to the general population. The majority of patients have an extended hypopituitarism that needs balanced hormone supplementation. About half of the patient population suffer from hypothalamic damage due to the tumour or operation. These patients suffer from hypothalamic obesity together with increased vascular morbidity and compromised bone health, thirst disorders as well as somnolence and sleep apnea. Cardiovascular risk factors need up front therapy. There is a need for centralising this rare aggressive and difficult tumour to only a few centres and that it will be managed by a multidisciplinary team with experienced neurosurgeons, endocrinologists, neurooncologists, neuroradiologists, and neuroopthamologists for a better prognosis.
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| 2. |
- Follin, Cecilia, et al.
(författare)
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Microstructure alterations in the hypothalamus in cranially radiated childhood leukaemia survivors but not in craniopharyngioma patients unaffected by hypothalamic damage
- 2017
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Ingår i: Clinical Endocrinology. - : Wiley. - 0300-0664. ; 87:4, s. 359-366
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Tidskriftsartikel (refereegranskat)abstract
- Objective: Metabolic complications are frequent in childhood leukaemia (ALL) survivors treated with cranial radiotherapy (CRT). These complications are potentially mediated by damage to the hypothalamus (HT), as childhood onset (CO) craniopharyngioma (CP) survivors without HT involvement are spared overt obesity. Diffusion tensor imaging (DTI) shows brain tissue microstructure alterations, by fractional anisotrophy (FA), mean diffusivity (MD), axial diffusivity (AD) and radial diffusivity (RD). We used DTI to determine the integrity of the microstructure of the HT in ALL survivors. Design: Case-control study. Patients: Three groups were included: (i) 27 CRT treated ALL survivors on hormone supplementation, (ii) 17 CO-CP survivors on hormone supplementation but without HT involvement and (iii) 27 matched controls. Measurements: DTI parameters of the HT were measured and body composition. Results: Microstructural alterations in the HT were more severe in ALL survivors with a BMI ≥25 than with BMI <25. Compared to controls, ALL survivors had reduced FA (P=.04), increased MD (P<.001), AD (P<.001) and RD (P<.001) in the right and left HT. In the right HT, ALL survivors with a BMI ≥25 showed elevated MD (P=.03) and AD (P=.02) compared to ALL survivors with BMI <25. In contrast, DTI parameters did not differ between CP survivors and controls. Conclusions: Long-term follow-up after CRT for ALL DTI measures were affected in the HT despite complete hormone replacement. The present data suggest that ALL survivors have demyelination and axonal loss in the HT.
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