Specific behaviour, mood and personality traits may contribute to obesity in patients with craniopharyngioma

IntroductionPatients with craniopharyngioma (CP) often suffer from obesity, but the underlying causes are still not fully understood. We compared CP to patients with nonfunctioning pituitary adenoma (NFPA) and to a control group (CG) using standardized questionnaires to investigate whether behavioural, mood or personality traits contribute to obesity. MethodsWe compared 31 patients with CP (42% male, 53151years) to 26 patients with NFPA (71% male, 632103years) and to age- and gender-matched local CG (ratio 2:1). Normative data from the literature are included for reference. Patients were asked to complete eleven standardized questionnaires. Two questionnaires were used to evaluate eating disorders (FEV, EDE-Q), one depression (BDI), one anxiety (STAI), three health-related quality of life (SF-36, EuroQoL, QoL-AGHDA), one sleepiness (Epworth Sleepiness Scale), two personality (EPQ-RK, TPQ) and one body image (FKB-20). ResultsPatients with CP scored significantly higher in conscious hunger perception (FEV, CP 58 +/- 32 scores, NFPA 36 +/- 33 scores, CG 30 +/- 25, P<0001). They had similar scores for BDI compared with NFPA, but higher scores to CG (P<0001, CP 106 +/- 83, NFPA 75 +/- 57, CG 496 +/- 42). CP and NFPA scored higher than CG for anxiety and personality traits such as harm avoidance, fatigability and asthenia and slightly higher for neuroticism. No differences were seen for EDE-Q, quality of life, daytime sleepiness and body image between CP and NFPA. However, differences could be observed to normative data from the literature. ConclusionObesity in patients with CP might be influenced by eating disorders, negative mood alterations and increased anxiety-related personality traits

Reduced sleep quality and depression associate with decreased quality of life in patients with pituitary adenomas

Objectives: Several studies reported decreased quality of life (QoL) and sleep as well as increased rates of depression for patients with pituitary adenomas. Our aim was to explore to what extent differences in depression and sleep quality contribute to differences in QoL between patients with pituitary adenomas and controls. Design: A cross-sectional case-control study. Setting: Endocrine Outpatient Unit of the Max Planck Institute of Psychiatry, Munich, Department of Internal Medicine, Ludwig-Maximilians-University, Munich, and the Institute of Clinical Psychology and Psychotherapy, Technical University, Dresden. Participants: Patients with pituitary adenomas (n = 247) and controls (from the DETECT cohort, a large epidemiological study in primary care patients) matched individually by age and gender (n = 757). Measurements: Sleep quality was assessed with the Pittsburgh Sleep Quality Index (PSQI) and QoL was measured by the generic EQ-5D and calculated by the time trade-off- and VAS-method. Depression was categorized as 'no depression', 'subclinical depression', and 'clinical depression' according to the Beck Depressions Inventory for patients and the Depression Screening Questionnaire for control subjects. Statistical analyses: General linear and generalized, logistic mixed models as well as proportional odds mixed models were calculated for analyzing differences in baseline characteristics and in different subgroups. Results: Patients with pituitary adenomas showed decreased QoL (VAS index: 0.73 +/- 0.19) and sleep (PSQI score: 6.75 +/- 4.17) as well as increased rates of depression ( subclinical or clinical depression: 41.4%) compared with their matched control subjects (VAS index: 0.79 +/- 0.18, PSQI score: 5.66 +/- 4.31, subclinical or clinical depression: 25.9%). We have shown that a substantial proportion of the reduced QoL (48% respectively 65%) was due to the incidence of depression and reduced sleep quality. Conclusions: These findings emphasize the importance of diagnosing depressive symptoms and sleep disturbances in patients with pituitary disease, with the ultimate goal to improve QoL in patients with pituitary adenomas

Food intake regulating hormones in adult craniopharyngioma patients

Introduction: Patients with craniopharyngioma (CP) have disturbances of the hypothalamic-pituitary axis and serious comorbidities such as obesity. We hypothesized that the secretion of hormones regulating the nutritional status is altered in adult patients with CP compared with patients with non-functioning pituitary adenoma (NFPA). Methods: We included 40 CP (50% males, mean age: 49.6 +/- 14.3 years) and 40 NFPA (72.5% males, mean age: 63.4 +/- 9.8 years) patients. We measured glucose, insulin, leptin, total ghrelin, peptide-YY (PYY) and cholecystokinin (CCK) during oral glucose tolerance test (OGTT). Fat mass ( FM) was determined by dual X-ray absorptiometry. Results: Gender distribution was not significantly different, but CP patients were significantly younger (P < 0.001). CP patients had significantly higher BMI and FM than NFPA patients ( BMI 32 +/- 8 vs 28G4 kg/ m(2), P=0.009 and FM 37 +/- 9 vs 33 +/- 9%, PZ0.02). Fasting glucose level ( 84 +/- 12 vs 78 +/- 11 mg/ dl, P=0.03), leptin (27.9 +/- 34.2 vs 11.9 +/- 11.6 upsilon g/ l, P=0.008) and leptin levels corrected for percentage FM (0.66 +/- 0.67 vs 0.32 +/- 0.25 mg/ l%, P=0.005) were significantly higher in CP than in NFPA patients, whereas ghrelin was significantly lower ( 131 +/- 129 vs 191 +/- 119 ng/l, P=0.035). Insulin, PYY and CCK did not differ significantly between groups. After glucose load, leptin decreased significantly in CP patients (P=0.019). In both groups, ghrelin decreased significantly during OGTT ( both P < 0.001). The percentage decline was significantly smaller for CP. PYYand CCK increased equally after glucose in both groups. Conclusion: Our patients with CP have more metabolic complications than our patients with NFPA. The levels of leptin and ghrelin at fasting status and after glucose seem to be altered in CP, whereas changes in insulin, PYY and CCK do not seem to be responsible for the metabolic changes in these patients

Clinical characteristics of pain in patients with pituitary adenomas

Objective: Clinical presentation of pituitary adenomas frequently involves pain, particularly headache, due to structural and functional properties of the tumour. Our aim was to investigate the clinical characteristics of pain in a large cohort of patients with pituitary disease. Design: In a cross-sectional study, we assessed 278 patients with pituitary disease (n=81 acromegaly; n=45 Cushing's disease; n=92 prolactinoma; n=60 non-functioning pituitary adenoma). Methods: Pain was studied using validated questionnaires to screen for nociceptive vs neuropathic pain components (painDETECT), determine pain severity, quality, duration and location (German pain questionnaire) and to assess the impact of pain on disability (migraine disability assessment, MIDAS) and quality of life (QoL). Results: We recorded a high prevalence of bodily pain (n=180, 65%) and headache (n=178, 64%); adrenocorticotropic adenomas were most frequently associated with pain (n= 34, 76%). Headache was equally frequent in patients with macro- and microadenomas (68 vs 60%; P=0.266). According to painDETECT, the majority of the patients had a nociceptive pain component (n=193, 80%). Despite high prevalence of headache, 72% reported little or no headache-related disability (MIDAS). Modifiable factors including tumour size, genetic predisposition, previous surgery, irradiation or medical therapy did not have significant impact neither on neuropathic pain components (painDETECT) nor on headache-related disability (MIDAS). Neuropathic pain and pain-related disability correlated significantly with depression and impaired QoL. Conclusions: Pain appears to be a frequent problem in pituitary disease. The data suggest that pain should be integrated in the diagnostic and therapeutic work-up of patients with pituitary disease in order to treat them appropriately and improve their QoL

New outlook on the diagnosis, treatment and follow-up of childhood-onset craniopharyngioma

Childhood-onset craniopharyngiomas are rare embryonic tumours of low-grade histological malignancy. Novel insights into the molecular pathogenesis of human adamantinomatous craniopharyngioma have started to unveil the possibility of testing novel treatments targeting pathogenic pathways. Hypothalamic involvement and/or treatment-related lesions result in impaired physical and social functionality and in severe neuroendocrine sequelae. Quality of survival in patients with craniopharyngioma with hypothalamic involvement is impaired by severe obesity, physical fatigue and non-optimal psychosocial development. Patients with craniopharyngioma involving hypothalamic structures have reduced 20-year overall survival, but overall and progression-free survival are not related to the degree of surgical resection. Irradiation is effective in the prevention of tumour progression and recurrence. For favourably localized craniopharyngiomas, the preferred treatment of choice is to attempt complete resection with preservation of visual, hypothalamic and pituitary function. For unfavourably localized tumours in close proximity to optic and/or hypothalamic structures, a radical neurosurgical strategy attempting complete resection is not recommended owing to potential severe sequelae. As expertise has been shown to have an impact on post-treatment morbidity, medical societies should establish criteria for adequate professional expertise for the treatment of craniopharyngioma. On the basis of these criteria, health authorities should organize the certification of centres of excellence that are authorized to treat and care for patients with this chronic disease