Diagnosis, background and treatment of hypothalamic damage in craniopharyngioma

Craniopharyngiomas (CPs) are rare brain tumours managed primarily with surgery and radiotherapy. There are two phenotypes of CPs, one with a rather good outcome without hypothalamic damage and the other with hypothalamic damage. With hypothalamic damage progressive disease with recurrent operations and additional cranial radiotherapy often result in hypothalamic obesity, affected psychosocial life and cognitive dysfunction. The morbidity and mortality is increased for particularly cerebrovascular diseases. Preoperative hypothalamic involvement to predict hypothalamic damage is important for decision making for hypothalamic sparing surgery. Also postoperative hypothalamic damage evaluation with the use of hypothalamus volume measurement can predict hypothalamic obesity, which is important for early treatment options. The morbidity of CPs includes cognitive dysfunction with attention deficits, impaired episodic memory and processing speed. Again patients with hypothalamic damage are more affected. Treatment options of hypothalamic obesity in the chronic phase are scarce and not convincingly successful. The most optimal situation is to try to hinder or stop hypothalamic obesity to evolve. Prevention of hypothalamic damage is recommended, with special regard to hypothalamus-sparing therapeutic approaches that respect the integrity of essential nuclei located in both the medial and the posterior hypothalamic areas.

Source: Neuroendocrinology - June 23, 2020 Category: Endocrinology Source Type: research