Hypothalamic involvement predicts cardiovascular risk in adults with childhood onset craniopharyngioma on long-term GH therapy.

TY - JOUR

T1 - Hypothalamic involvement predicts cardiovascular risk in adults with childhood onset craniopharyngioma on long-term GH therapy.

AU - Holmer, Helene

AU - Ekman, Bertil

AU - Björk, Jonas

AU - Nordström, Carl-Henrik

AU - Popovic, Vera

AU - Siverson, Annbritt

AU - Erfurth, Eva Marie

PY - 2009

Y1 - 2009

N2 - Context: Craniopharyngioma patients without GH therapy are at an increased cardiovascular disease (CVD) risk and particularly concerning women. No previous study on long-term GH therapy in adults with childhood onset (CO) craniopharyngioma was identified. Objective: To investigate CVD risk in adults with CO craniopharyngioma, on complete hormone replacement, including long-term GH therapy, and to investigate the impact of disease-related factors on CVD risk. Design and Participants: In a cross-sectional study of operated CO craniopharyngiomas (1958-2000) from a defined area of Sweden (2.5 million) we enrolled 42 patients (20 women) with a median age 28 (range 17-57) years and assessed CVD risk 20 (4-40) years after first operation. Comparisons were made with matched controls and between patients with tumour growth into the third ventricle (TGTV) vs non-TGTV. GH therapy was 10-12 years in women and men. Results: In comparison to controls, both male and female patients had increased BMI, fat mass, insulin and leptin levels. Overall, while not significantly increased in male patients, 55-60% of female patients had a medium-high CVD risk, compared to 10-20% in controls. An increased CVD risk (all P < 0.05) and higher levels of fat mass and insulin were recorded in the TGTV group vs the non-TGTV group. Late puberty induction and lack of androgens were shown in female patients. Conclusions: Adult patients with CO craniopharyngioma, especially those with TGTV, have persistently increased CVD risk. Conventional hormone substitution, including GH, is insufficient to normalize CVD risk, suggesting an important role for irreversible hypothalamic dysfunction.

AB - Context: Craniopharyngioma patients without GH therapy are at an increased cardiovascular disease (CVD) risk and particularly concerning women. No previous study on long-term GH therapy in adults with childhood onset (CO) craniopharyngioma was identified. Objective: To investigate CVD risk in adults with CO craniopharyngioma, on complete hormone replacement, including long-term GH therapy, and to investigate the impact of disease-related factors on CVD risk. Design and Participants: In a cross-sectional study of operated CO craniopharyngiomas (1958-2000) from a defined area of Sweden (2.5 million) we enrolled 42 patients (20 women) with a median age 28 (range 17-57) years and assessed CVD risk 20 (4-40) years after first operation. Comparisons were made with matched controls and between patients with tumour growth into the third ventricle (TGTV) vs non-TGTV. GH therapy was 10-12 years in women and men. Results: In comparison to controls, both male and female patients had increased BMI, fat mass, insulin and leptin levels. Overall, while not significantly increased in male patients, 55-60% of female patients had a medium-high CVD risk, compared to 10-20% in controls. An increased CVD risk (all P < 0.05) and higher levels of fat mass and insulin were recorded in the TGTV group vs the non-TGTV group. Late puberty induction and lack of androgens were shown in female patients. Conclusions: Adult patients with CO craniopharyngioma, especially those with TGTV, have persistently increased CVD risk. Conventional hormone substitution, including GH, is insufficient to normalize CVD risk, suggesting an important role for irreversible hypothalamic dysfunction.

U2 - 10.1530/EJE-09-0449

DO - 10.1530/EJE-09-0449

M3 - Article

VL - 161

SP - 671

EP - 679

JO - European Journal of Endocrinology

JF - European Journal of Endocrinology

SN - 1479-683X

ER -