Document Detail

Gastric bypass surgery for treatment of hypothalamic obesity after craniopharyngioma therapy.
MedLine Citation:
PMID:  17643131     Owner:  NLM     Status:  MEDLINE    
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/m(2)) 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.
Thomas H Inge; Paul Pfluger; Meg Zeller; Susan R Rose; Lukas Burget; Sumana Sundararajan; Stephen R Daniels; Matthias H Tschöp
Publication Detail:
Type:  Case Reports; Journal Article; Research Support, N.I.H., Extramural    
Journal Detail:
Title:  Nature clinical practice. Endocrinology & metabolism     Volume:  3     ISSN:  1745-8374     ISO Abbreviation:  -     Publication Date:  2007 Aug 
Date Detail:
Created Date:  2007-07-23     Completed Date:  2007-08-09     Revised Date:  2007-12-03    
Medline Journal Info:
Nlm Unique ID:  101261798     Medline TA:  Nat Clin Pract Endocrinol Metab     Country:  England    
Other Details:
Languages:  eng     Pagination:  606-9     Citation Subset:  IM    
Division of Pediatric General and Thoracic Surgery, ML 2023, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229-3039, USA.
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MeSH Terms
Combined Modality Therapy / adverse effects
Craniopharyngioma / therapy*
Gastric Bypass / methods*
Hyperinsulinism / etiology,  physiopathology
Hypopituitarism / etiology,  physiopathology
Hypothalamic Diseases / complications*,  etiology
Obesity / etiology*,  physiopathology,  surgery*
Pituitary Neoplasms / therapy*
Grant Support

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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