Department of Pediatrics, University of California San Francisco San Francisco, CA, USA.
Front Endocrinol (Lausanne). 2011 Nov 3;2:60. doi: 10.3389/fendo.2011.00060. eCollection 2011.
Obesity is a common complication after craniopharyngioma therapy, occurring in up to 75% of survivors. Its weight gain is unlike that of normal obesity, in that it occurs even with caloric restriction, and attempts at lifestyle modification are useless to prevent or treat the obesity. The pathogenesis of this condition involves the inability to transduce afferent hormonal signals of adiposity, in effect mimicking a state of CNS starvation. Efferent sympathetic activity drops, resulting in malaise and reduced energy expenditure, and vagal activity increases, resulting in increased insulin secretion and adipogenesis. Lifestyle intervention is essentially useless in this syndrome, termed "hypothalamic obesity." Pharmacologic treatment is also difficult, consisting of adrenergics to mimic sympathetic activity, or suppression of insulin secretion with octreotide, or both. Recently, bariatric surgery (Roux-en-Y gastric bypass, laparoscopic gastric banding, truncal vagotomy) have also been attempted with variable results. Early and intensive management is required to mitigate the obesity and its negative consequences.
肥胖是颅咽管瘤治疗后的常见并发症，高达 75%的幸存者会出现这种情况。它的体重增加与正常肥胖不同，即使限制热量摄入，生活方式的改变也无法预防或治疗肥胖。这种情况的发病机制涉及到无法传递肥胖的传入激素信号，实际上模拟了中枢神经系统饥饿的状态。传出交感神经活动下降，导致不适和能量消耗减少，而迷走神经活动增加，导致胰岛素分泌增加和脂肪生成。生活方式干预在这种被称为“下丘脑性肥胖”的综合征中基本无效。药物治疗也很困难，包括用拟交感神经药物模拟交感神经活动，或用奥曲肽抑制胰岛素分泌，或两者兼用。最近，减重手术（Roux-en-Y 胃旁路术、腹腔镜胃带术、胃短路手术）也已尝试，但结果不一。需要早期和强化管理来减轻肥胖及其不良后果。
