Van Schaik J, Burghard M, Lequin M H, van Maren E A, van Dijk A M, Takken T, Rehorst-Kleinlugtenbelt L B, Bakker B, Meijer L, Hoving E W, Fiocco M, Schouten-van Meeteren A Y N, Tissing W J E, van Santen H M
Division of Pediatric Endocrinology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands.
Division of Pediatric Oncology, Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands.
Endocr Connect. 2022 Jul 21;11(8). doi: 10.1530/EC-22-0276. Print 2022 Aug 1.
Children with suprasellar brain damage are at risk of hypothalamic dysfunction (HD). HD may lead to decreased resting energy expenditure (REE). Decreased REE, however, is not present in all children with HD. Our aim was to assess which children suspect for HD have low REE, and its association with clinical severity of HD or radiological hypothalamic damage.
A retrospective cohort study was performed. Measured REE (mREE) of children at risk of HD was compared to predicted REE (pREE). Low REE was defined as mREE <90% of predicted. The mREE/pREE quotient was associated to a clinical score for HD symptoms and to radiological hypothalamic damage.
In total, 67 children at risk of HD (96% brain tumor diagnosis) with a mean BMI SDS of +2.3 ± 1.0 were included. Of these, 45 (67.2%) had low mREE. Children with severe HD had a significant lower mean mREE/pREE quotient compared to children with no, mild, or moderate HD. Mean mREE/pREE quotient of children with posterior hypothalamic damage was significantly lower compared to children with no or anterior damage. Tumor progression or tumor recurrence, severe clinical HD, and panhypopituitarism with diabetes insipidus (DI) were significant risk factors for reduced REE.
REE may be lowered in children with hypothalamic damage and is associated to the degree of clinical HD. REE is, however, not lowered in all children suspect for HD. For children with mild or moderate clinical HD symptoms, REE measurements may be useful to distinguish between those who may benefit from obesity treatment that increases REE from those who would be better helped using other obesity interventions.
鞍上脑损伤患儿存在下丘脑功能障碍（HD）风险。HD可能导致静息能量消耗（REE）降低。然而，并非所有HD患儿的REE都会降低。我们的目的是评估哪些疑似HD的患儿REE较低，以及其与HD临床严重程度或下丘脑放射性损伤的关联。
进行了一项回顾性队列研究。将有HD风险患儿的实测REE（mREE）与预测REE（pREE）进行比较。低REE定义为mREE<预测值的90%。mREE/pREE商与HD症状临床评分及下丘脑放射性损伤相关。
共纳入67例有HD风险的患儿（96%诊断为脑肿瘤），平均BMI SDS为+2.3±1.0。其中，45例（67.2%）mREE较低。与无HD、轻度HD或中度HD的患儿相比，重度HD患儿的平均mREE/pREE商显著更低。与无下丘脑损伤或仅有下丘脑前部损伤的患儿相比，下丘脑后部损伤患儿的平均mREE/pREE商显著更低。肿瘤进展或复发、重度临床HD以及伴有尿崩症（DI）的全垂体功能减退是REE降低的显著危险因素。
下丘脑损伤患儿的REE可能降低，且与临床HD程度相关。然而，并非所有疑似HD的患儿REE都会降低。对于有轻度或中度临床HD症状的患儿，测量REE可能有助于区分哪些患儿可能从增加REE的肥胖治疗中获益，哪些患儿采用其他肥胖干预措施会得到更好的帮助。
