Temporal trends in craniopharyngioma management and long-term endocrine outcomes: A multicentre cross-sectional study.

Autor: Hussein Z; Department of Endocrinology, University College London Hospital, London, UK.; Department of Medicine, University College London, London, UK., Glynn N; Department of Endocrinology, St Bartholomew's Hospital, Bart's Health NHS Trust, London, UK., Martin N; Division of Diabetes, Endocrinology and Metabolism, Imperial College London, UK., Alkrekshi A; Internal Medicine, The Metro Health System Campus of Case Western Reserve University, Cleveland, USA., Mendoza N; Department of Neurosurgery, Imperial College Healthcare NHS Trust, London, UK., Nair R; Department of Neurosurgery, Imperial College Healthcare NHS Trust, London, UK., McCullough K; Department of Diabetes and Endocrinology, Royal Surrey County Hospital, Guildford, UK., Marcus HJ; Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, UK., Dorward N; Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, UK., Grieve J; Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, UK., Fersht N; Department of Oncology, University College London Hospital, London, UK., Dyson E; Department of Neurosurgery, Great Ormond Street Hospital NHS Foundation Trust, London, UK., Bouloux PM; Centre for Neuroendocrinology, Royal Free Campus, University College London, London, UK., Druce M; Department of Endocrinology, St Bartholomew's Hospital, Bart's Health NHS Trust, London, UK.; Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK., Baldeweg SE; Department of Endocrinology, University College London Hospital, London, UK.; Department of Medicine, University College London, London, UK.
Jazyk: angličtina
Zdroj: Clinical endocrinology [Clin Endocrinol (Oxf)] 2021 Feb; Vol. 94 (2), pp. 242-249. Date of Electronic Publication: 2020 Sep 29.
DOI: 10.1111/cen.14334
Abstrakt: Background: The optimal management of craniopharyngiomas remains controversial.
Objectives: To examine temporal trends in the management of craniopharyngioma with a focus on endocrine outcomes.
Methods: This was a cross-sectional, multicentre study. Patients treated between 1951 and 2015 were identified and divided into four quartiles. Demographics, presentation, treatment and outcomes were collected.
Results: In total, 142 patients with childhood-onset craniopharyngioma (48/142; 34%) and adult-onset disease (94/142; 66%) were included. The median follow-up was 15 years (IQR 5-23 years). Across quartiles, there was a significant trend towards using transsphenoidal surgery (P < .0001). The overall use of radiotherapy was not different among the four quartiles (P = .33). At the latest clinical review, the incidence of GH, ACTH, gonadotrophin deficiencies and anterior panhypopituitarism fell significantly across the duration of the study. Anterior panhypopituitarism was not affected by treatment modality (surgery vs surgery and radiotherapy) (P = .23). There was no difference in the incidence of high BMI (≥25 kg/m 2 ) among the four quartiles (P = .14). BMI was higher in patients who treated with surgery and radiotherapy than those treated with surgery only (P = .006). Tumour regrowth occurred in 51 patients (51/142; 36%) with no difference in regrowth among quartiles over the time course of the study (P = .15).
Conclusion: We demonstrate a significant reduction in panhypopituitarism in craniopharyngioma patients over time, most likely because of a trend towards more transsphenoidal surgery. However, long-term endocrine sequelae remain common and lifelong follow-up is required.
(© 2020 The Authors. Clinical Endocrinology published by John Wiley & Sons Ltd.)
Databáze: MEDLINE
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