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Practical approach to childhood craniopharyngioma: A role of an endocrinologist and a general paediatrician
Child's Nervous System, 06/23/09

Kalina MA et al. – Management of craniopharyngioma in a single-institution study included repeat hormonal and metabolic assays in chosen time intervals, with an interdisciplinary team for early detection and management of co-morbidities.

• Study of co-morbidities in pts with craniopharyngioma
• Elaboration of an interdisciplinary follow-up protocol
• Subjects: 15 children; median age at diagnosis, 10.1 yrs; mean follow-up period, 4 yrs
• Surgical tumor resection: gross total in 7, subtotal or partial removal in 8 cases
• Post-surgical radiotherapy in 10 cases for tumor residue or progression
• Evaluation of sexual development and auxology at diagnosis and during follow-up
• Determination of hormones by chemiluminescent immunometric assays
• Diagnosis of antidiuretic hormone dysfunction by clinical symptoms, water-electrolyte balance, urine specific gravity, and serum osmolality
• Assessment of metabolic control by levels of glucose, insulin, lipids, and transaminases
• Homeostatic model assessment (HOMA) index for insulin resistance

• At diagnosis, median height standard deviation score (hSDS): -1.6 (5 children being short)
• Median change hSDS for whole follow-up: 1.2 (4 children decelerating growth)
• Diabetes insipidus diagnosed in 8 (within 0–1.8 yrs of follow-up), hypocorticolism in 8, and hypothyroidism in 12 subjects (within 0–3.75 yrs for both endocrinopathies)
• Sex hormone replacement therapy required by 4 pts
• At diagnosis, 5 overweight children
• During follow-up, only 4 children sustained normal body mass index
• Hypertransaminasaemia in 3, dyslipidaemia in 11, and hyperinsulinaemia in 7 pts (with elevated HOMA in 4 cases)

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