Nature clinical practice. Endocrinology & metabolism · 2007
Gastric bypass surgery for treatment of hypothalamic obesity after craniopharyngioma therapy.
Клинический случайСтатьяПоддержка NIH: внешняя программаНазвание и аннотация: Перевод в очереди
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Inge Thomas H, Pfluger Paul, Zeller Meg, Rose Susan R, Burget Lukas, Sundararajan Sumana, Daniels Stephen R, Tschöp Matthias H
Аннотация
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.
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.