Müller H L, Heinrich M, Bueb K, Etavard-Gorris N, Gebhardt U, Kolb R, Sörensen N
Department of Pediatrics, Zentrum für Kinder- und Jugendmedizin, Klinikum Oldenburg gGmbH, Oldenburg, Germany.
Exp Clin Endocrinol Diabetes. 2003 Sep;111(6):330-4. doi: 10.1055/s-2003-42722.
The substitution of dexamethasone during and after surgery of childhood craniopharyngioma is necessary in order to treat and/or prevent brain edema and adrenal insufficiency. Early post-operative weight gain is a predictor for severe obesity during long-term follow-up. In a retrospective analysis of 60 patients with childhood craniopharyngioma we inquired whether dose and duration of perioperative dexamethasone therapy (n = 68) had influence on short-term post-operative weight gain and long-term development of severe obesity. The median follow-up period was 4.2 years, ranging from 1 to 9 years. 24 patients (14 f/10 m) developed severe obesity (BMI > 3 SD). 28 patients (10 f/18 m) retained normal weight (BMI < 2 SD). Eight patients presented with a BMI between 2 and 3 SD at the final visit. Differences in terms of age at surgery or follow-up period were non-detectable between the analyzed groups of craniopharyngioma patients. Duration and cumulative dexamethasone doses (mg/m2 BSA) for perioperative dexamethasone therapy were similar for severely obese patients (duration: 8.7 d; 4.5 - 17 d, cumulative dose: 74; 42 - 177 mg/m2 BSA) and normal weight patients (duration: 10.0 d; 1 - 41 d; dose: 76; 9 - 390 mg/m2 BSA). Whereas cumulative dexamethasone doses positively (p < 0.01; rho: 0.424) correlated with weight gain during the first year following surgery, long-term development of severe obesity was not influenced by dose and duration of perioperative dexamethasone treatment. Patients who developed severe obesity during follow-up had a higher (p < 0.001) BMI already at the time of diagnosis. We conclude that dose and duration of perioperative dexamethasone treatment had short-term effects on post-operative weight gain, but not on the development of long-term severe obesity. The results of our retrospective analysis are currently tested in a prospective surveillance study Kraniopharyngeom 2000 (www.kraniopharyngeom.com).
儿童颅咽管瘤手术期间及术后使用地塞米松替代治疗对于治疗和/或预防脑水肿及肾上腺功能不全是必要的。术后早期体重增加是长期随访中重度肥胖的一个预测指标。在一项对60例儿童颅咽管瘤患者的回顾性分析中，我们探究围手术期地塞米松治疗（n = 68）的剂量和疗程是否会对术后短期体重增加及重度肥胖的长期发展产生影响。中位随访期为4.2年，范围为1至9年。24例患者（14例女性/10例男性）出现重度肥胖（BMI > 3个标准差）。28例患者（10例女性/18例男性）体重保持正常（BMI < 2个标准差）。8例患者在最后一次随访时BMI介于2至3个标准差之间。在分析的颅咽管瘤患者组之间，手术时年龄或随访期方面的差异未被检测到。重度肥胖患者和体重正常患者围手术期地塞米松治疗的疗程及累积地塞米松剂量（mg/m²体表面积）相似（疗程：重度肥胖患者8.7天；4.5 - 17天，累积剂量：74；42 - 177 mg/m²体表面积；体重正常患者10.0天；1 - 41天；剂量：76；9 - 390 mg/m²体表面积）。虽然累积地塞米松剂量与术后第一年的体重增加呈正相关（p < 0.01；rho：0.424），但围手术期地塞米松治疗的剂量和疗程并未影响重度肥胖的长期发展。随访期间出现重度肥胖的患者在诊断时BMI就已经较高（p < 0.001）。我们得出结论，围手术期地塞米松治疗的剂量和疗程对术后体重增加有短期影响，但对长期重度肥胖的发展没有影响。我们回顾性分析的结果目前正在一项前瞻性监测研究Kraniopharyngeom 2000（www.kraniopharyngeom.com）中进行验证。
