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01.09.2009 | Original Paper | Ausgabe 9/2009

Child's Nervous System 9/2009

Practical approach to childhood craniopharyngioma: a role of an endocrinologist and a general paediatrician

Zeitschrift:
Child's Nervous System > Ausgabe 9/2009
Autoren:
Maria A. Kalina, Eliza Skala-Zamorowska, Barbara Kalina-Faska, Ewa Malecka-Tendera, Marek Mandera
Wichtige Hinweise
Data included in this paper were presented at the “Consensus Conference on Pediatric Neurosurgery, First Interim Meeting of the European Society for Pediatric Neurosurgery. Too much, too little? Craniopharyngiomas, ependymomas”, Rome 23–24 January 2009.

Abstract

Objectives

The objectives of this study are to evaluate co-morbidities in patients with craniopharyngioma and to elaborate an interdisciplinary protocol of the follow-up.

Patients and methods

The group comprised 15 children (median age at the diagnosis, 10.1; mean follow-up period, 4 years). All patients had surgical resection of the tumour: gross total in seven, subtotal or partial removal in eight cases. Surgery was followed by radiotherapy in ten cases for tumour residue or progression. Sexual development and auxology were evaluated at diagnosis and during follow-up. Hormones were determined by chemiluminescent immunometric assays. Antidiuretic hormone dysfunction was diagnosed on the grounds of clinical symptoms, water-electrolyte balance, urine specific gravity, and serum osmolality. Metabolic control was monitored by levels of glucose, insulin, lipids, and transaminases; insulin resistance was expressed by homeostatic model assessment (HOMA) index.

Results

At diagnosis, median height standard deviation score (hSDS) was −1.6 (five children being short-statured). Median change hSDS for the whole follow-up was 1.2 (four children decelerating growth). Diabetes insipidus was diagnosed in eight (within 0–1.8 years of the follow-up), hypocorticolism in eight, and hypothyroidism in 12 subjects (within 0–3.75 years for both endocrinopathies). Four patients required sex hormone replacement therapy. At diagnosis, five children were overweight; during follow-up, only four children sustained normal body mass index. Hypertransaminasaemia was found in three, dyslipidaemia in 11, and hyperinsulinaemia in seven patients (with elevated HOMA in four cases).

Conclusions

On the grounds of these observations, the management of craniopharyngioma in our institution includes repeated hormonal and metabolic assays in chosen time intervals. Early detection of co-morbidities and their management involves interdisciplinary team.

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