Childhood craniopharyngioma: greater hypothalamic involvement before surgery is associated with higher homeostasis model insulin resistance index

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• 作者：Christine Trivin (1)
  Kanetee Busiah (2)
  Nizar Mahlaoui (2)
  Christophe Recasens (3)
  Jean-Claude Souberbielle (1)
  Michel Zerah (4)
  Christian Sainte-Rose (4)
  Raja Brauner (2)
  
• 刊名：BMC Pediatrics
• 出版年：2009
• 出版时间：December 2009
• 年：2009
• 卷：9
• 期：1
• 全文大小：198KB
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  27. The pre-publication history for this paper can be accessed here:http://www.biomedcentral.com/1471-2431/9/24/prepub
  
• 作者单位：Christine Trivin (1)
  Kanetee Busiah (2)
  Nizar Mahlaoui (2)
  Christophe Recasens (3)
  Jean-Claude Souberbielle (1)
  Michel Zerah (4)
  Christian Sainte-Rose (4)
  Raja Brauner (2)
  
  1. AP-HP, H?pital Necker-Enfants Malades, Service d'Explorations Fonctionnelles, 75743, Paris, France
  2. Université Paris Descartes and AP-HP, H?pital Bicêtre, Unité d'Endocrinologie Pédiatrique, 94275, Le Kremlin Bicêtre, France
  3. AP-HP, H?pital Albert Chenevier, Service de Psychiatrie, Créteil, 94000, France
  4. Université Paris Descartes and AP-HP, H?pital Necker-Enfants Malades, Service de Neurochirurgie Pédiatrique, 75743, Paris, France
  

文摘

Background Obesity seems to be linked to the hypothalamic involvement in craniopharyngioma. We evaluated the pre-surgery relationship between the degree of this involvement on magnetic resonance imaging and insulin resistance, as evaluated by the homeostasis model insulin resistance index (HOMA). As insulin-like growth factor 1, leptin, soluble leptin receptor (sOB-R) and ghrelin may also be involved, we compared their plasma concentrations and their link to weight change. Methods 27 children with craniopharyngioma were classified as either grade 0 (n = 7, no hypothalamic involvement), grade 1 (n = 8, compression without involvement), or grade 2 (n = 12, severe involvement). Results Despite having similar body mass indexes (BMI), the grade 2 patients had higher glucose, insulin and HOMA before surgery than the grade 0 (P = 0.02, <0.05 and 0.02 respectively) and 1 patients (P < 0.02 and <0.03 for both insulin and HOMA). The grade 0 (5.8 ± 4.9) and 1 (7.2 ± 5.3) patients gained significantly less weight (kg) during the year after surgery than did the grade 2 (16.3 ± 7.4) patients. The pre-surgery HOMA was positively correlated with these weight changes (P < 0.03). The data for the whole population before and 6-8 months after surgery showed increases in BMI (P < 0.0001), insulin (P < 0.005), and leptin (P = 0.0005), and decreases in sOB-R (P < 0.04) and ghrelin (P < 0.03). Conclusion The hypothalamic involvement by the craniopharyngioma before surgery seems to determine the degree of insulin resistance, regardless of the BMI. The pre-surgery HOMA values were correlated with the post-surgery weight gain. This suggests that obesity should be prevented by reducing inn secretion in those cases with hypothalamic involvement.