Gender differences in surgical outcomes and predictors of long term endocrine and metabolic morbidity in adults with craniopharyngioma.

OBJECTIVE

To analyze surgical outcomes in adults with craniopharyngioma (CP) and to identify predictors of long-term endocrine-metabolic morbidity.

METHODS

Retrospective, bi-institutional cohort study of adults (≥ 18 y) treated at Ramón y Cajal University Hospital (Spain) or the University of South Florida Endocrinology & Diabetes Center (USA). Uniform endocrine protocols and ≥ 1 year of postoperative follow-up were required. Paired axis-by-axis hormonal assessment, body mass index (BMI) tracking, and registry-matched standardized prevalence ratios (SPR) for diabetes, hypertension and dyslipidemia were estimated.

RESULTS

Fifty-one histologically confirmed CP patients (19 women and 32 males) were included. The median follow-up was 6 years (range 3–21). At diagnosis, men had larger tumors (3.0 ± 0.9 vs. 2.4 ± 0.7 cm; p = 0.038), more mixed solid–cystic morphology (72% vs. 46%; p = 0.030) and a higher prevalence of LH/FSH deficiency (41% vs. 7%, p = 0.043). Transsphenoidal surgery predominated (71%) and gross total resection was achieved in 63% of the patients. Radiotherapy was the only independent predictor of persistent visual loss (odds ratio [OR] = 1.62; p = 0.002). At last follow-up, 44% of the patients acquired ≥ 1 new pituitary deficit, most frequently of TSH (24%) and ACTH (30%); craniotomy independently increased the number of altered axes (p = 0.001) and being male independently predicted new-onset TSH deficiency (OR = 1.3 [1.1–2.1], p = 0.003). Obesity prevalence remained high after surgery (71%) and suprasellar location predicted higher final BMI (OR = 5.3; p = 0.014). Diabetes was markedly over-represented (SPR 3.64 for Spain; 2.53 for USA), whereas hypertension SPRs were neutral and dyslipidemia was 70% higher in Spain. Radiotherapy, residual tumor and BMI independently predicted metabolic outcomes.

CONCLUSIONS

Despite curative-intended surgery adult survivors with CP experience substantial endocrine and metabolic morbidity, driven by tumor topography, surgical route and adjuvant radiotherapy. Lifelong, multidisciplinary surveillance—coupling endocrine replacement with aggressive cardiometabolic management—is essential to mitigate this burden.