Inge Thomas H, Pfluger Paul, Zeller Meg, Rose Susan R, Burget Lukas, Sundararajan Sumana, Daniels Stephen R, Tschöp Matthias H
Division of Pediatric General and Thoracic Surgery, ML 2023, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229-3039, USA.
Nat Clin Pract Endocrinol Metab. 2007 Aug;3(8):606-9. doi: 10.1038/ncpendmet0579.
A 14-year-old boy presented with daytime somnolence, intermittent emesis and hypothyroidism. Neuroimaging revealed a calcified suprasellar intracranial mass, suspected to be a craniopharyngioma. Subtotal resection of the tumor confirmed the diagnosis. Extreme obesity (BMI >60 kg/m(2)) and hyperinsulinemia followed tumor resection and cranial irradiation. Dietary interventions were unsuccessful, and pharmacologic intervention (i.e. octreotide) only slowed the rate of weight gain.
Radiography documented the suprasellar mass. Following surgical resection and radiotherapy, hypothalamic-pituitary deficiencies were found. Preprandial and postprandial excursions of insulin, active ghrelin and leptin were measured before and after gastric bypass surgery.
Panhypopituitarism, hypothalamic obesity and hyperinsulinemia following craniopharyngioma therapy.
Severe caloric restriction, octreotide, and pituitary hormone replacement did not produce weight loss. Gastric bypass surgery led to reduced food cravings, significant weight loss, and amelioration of obesity-related comorbidities. Correction of fasting hyperinsulinemia, normalization of postprandial insulin responses, and reductions in active ghrelin and leptin concentrations were also observed.
一名14岁男孩出现白天嗜睡、间歇性呕吐和甲状腺功能减退。神经影像学检查发现鞍上颅内有一钙化肿块，怀疑为颅咽管瘤。肿瘤次全切除确诊了该诊断。肿瘤切除和颅脑放疗后出现极度肥胖（BMI>60kg/m²）和高胰岛素血症。饮食干预未成功，药物干预（即奥曲肽）仅减缓了体重增加速度。
放射成像记录了鞍上肿块。手术切除和放疗后，发现下丘脑 - 垂体功能减退。在胃旁路手术前后测量了胰岛素、活性胃饥饿素和瘦素的餐前和餐后波动情况。
颅咽管瘤治疗后出现全垂体功能减退、下丘脑性肥胖和高胰岛素血症。
严格的热量限制、奥曲肽和垂体激素替代治疗均未导致体重减轻。胃旁路手术减少了食物渴望，显著减轻了体重，并改善了肥胖相关的合并症。还观察到空腹高胰岛素血症得到纠正、餐后胰岛素反应正常化以及活性胃饥饿素和瘦素浓度降低。
