Dulanjalee Kariyawasam

Objective Adamantinomatous craniopharyngioma mainly affects children. Excessive weight gain is a major long-term complication. The primary objective of this study was to assess long-term weight changes in children treated for craniopharyngioma. The secondary objectives were to identify risk factors for excessive weight gain and to look for associations with hypothalamic damage by the tumour or treatment. Design Single-centre retrospective cohort study Method Children managed for craniopharyngioma at our centre between 1990 and 2019 were included. The body mass index (BMI) standard deviation scores (SDS) at baseline and at last follow-up were compared. Univariate and multivariate analyses were performed in order to identify variables associated with the long-term BMI-SDS variation. Results The 108 patients had a mean follow-up of 10.4 years. The mean BMI-SDS increase over time was 2.11 (p < 0.001) overall, 1.21 (p < 0.001) in the group without hypothalamic involvement by the tumour, and 1.95 (p < 0.001) in the group managed using intended hypothalamus-sparing surgery. Absence of hypothalamic involvement by the tumour or treatment was significantly associated with less weight gain (p = 0.046 and p < 0.01, respectively). After adjustment, factors associated with a BMI-SDS change greater than 2 were female sex (p = 0.023), tumour involving the hypothalamus (p = 0.04), and higher baseline BMI (p < 0.001). Conclusion Clinically significant weight gain occurred in nearly all children treated for craniopharyngioma, including those whose hypothalamus was spared by the tumour and intentionally by treatment. However, hypothalamus integrity was associated with less weight gain. Despite hypothalamus-sparing strategies, hypothalamic obesity remains a major concern, indicating a need for novel treatment approaches.