Efficacy and safety of bariatric surgery for craniopharyngioma-related hypothalamic obesity: a matched case–control study with 2 years of follow-up

• Published in: International Journal of Obesity Vol. 41; no. 2; pp. 210 - 216
• Main Authors: Wijnen, M, Olsson, D S, van den Heuvel-Eibrink, M M, Wallenius, V, Janssen, J A M J L, Delhanty, P J D, van der Lely, A J, Johannsson, G, Neggers, S J C M M
• Format: Journal Article
• Language: English
• Published: London Nature Publishing Group UK 01.02.2017; Nature Publishing Group
• Subjects: 692/163/2743/393; 692/698/1460; 692/699/1702/393; 692/699/67/1922; 692/700/2817; 692/700/565/545/2098; Adolescent; Adult; Bariatric surgery; Body weight loss; Brain tumors; Care and treatment; Case studies; Case-Control Studies; Child; Child, Preschool; Complications and side effects; Craniopharyngioma - complications; Craniopharyngioma - drug therapy; Craniopharyngioma - surgery; Development and progression; Endocrinology and Diabetes; Endokrinologi och diabetes; Epidemiology; Female; Follow-Up Studies; Gastrectomy; Gastric Bypass; Gastrointestinal surgery; Health Promotion and Disease Prevention; Hormone replacement therapy; Humans; Hypothalamus; Internal Medicine; Male; Medicine; Medicine & Public Health; Meta-analysis; Metabolic Diseases; Neoplasia; Netherlands - epidemiology; Obesity; Obesity - etiology; Obesity - surgery; original-article; Patient outcomes; Patients; Pituitary; Pituitary gland tumors; Pituitary Neoplasms - complications; Pituitary Neoplasms - drug therapy; Pituitary Neoplasms - surgery; Public Health; Retrospective Studies; Safety; Surgery; Sweden - epidemiology; Systematic review; Therapy; Treatment Outcome; Weight control; Weight Loss; Young Adult; Netherlands
• ISSN: 0307-0565; 1476-5497; 1476-5497
• DOI: 10.1038/ijo.2016.195

Background: Hypothalamic obesity is a devastating consequence of craniopharyngioma. Bariatric surgery could be a promising therapeutic option. However, its efficacy and safety in patients with craniopharyngioma-related hypothalamic obesity remain largely unknown. Objectives: We investigated the efficacy of bariatric surgery for inducing weight loss in patients with craniopharyngioma-related hypothalamic obesity. In addition, we studied the safety of bariatric surgery regarding its effects on hormone replacement therapy for pituitary insufficiency. Methods: In this retrospective matched case–control study, we compared weight loss after bariatric surgery (that is, Roux-en-Y gastric bypass and sleeve gastrectomy) between eight patients with craniopharyngioma-related hypothalamic obesity and 75 controls with ‘common’ obesity during 2 years of follow-up. We validated our results at 1 year of follow-up in a meta-analysis. In addition, we studied alterations in hormone replacement therapy after bariatric surgery in patients with craniopharyngioma. Results: Mean weight loss after bariatric surgery was 19% vs 25% (difference −6%, 95% confidence of interval (CI) −14.1 to 4.6; P =0.091) at 2 years of follow-up in patients with craniopharyngioma-related hypothalamic obesity compared with control subjects with ‘common’ obesity. Mean weight loss was 25% vs 29% (difference −4%, 95% CI −11.6 to 8.1; P =0.419) after Roux-en-Y gastric bypass and 10% vs 20% (difference −10%, 95% CI −14.1 to −6.2; P =0.003) after sleeve gastrectomy at 2 years of follow-up in patients with craniopharyngioma-related hypothalamic obesity vs control subjects with ‘common’ obesity. Our meta-analysis demonstrated significant weight loss 1 year after Roux-en-Y gastric bypass, but not after sleeve gastrectomy. Seven patients with craniopharyngioma suffered from pituitary insufficiency; three of them required minor adjustments in hormone replacement therapy after bariatric surgery. Conclusions: Weight loss after Roux-en-Y gastric bypass, but not sleeve gastrectomy, was comparable between patients with craniopharyngioma-related hypothalamic obesity and control subjects with ‘common’ obesity at 2 years of follow-up. Bariatric surgery seems safe regarding its effects on hormone replacement therapy.