Gjersdal Erlend, Klit Frederik Østergaard, Schmidt Ettrup Kåre, Vestergaard Peter, Nielsen Eigil Husted, Vistisen Kristian Nilsson, Müller Hermann L, Melgaard Dorte, Dal Jakob
Department of Endocrinology, Aalborg University Hospital, Aalborg, Denmark.
Steno Diabetes Center North Denmark, Aalborg, Denmark.
Pituitary. 2025 Aug 19;28(5):93. doi: 10.1007/s11102-025-01564-7.
Hypothalamic obesity is a severe complication of craniopharyngioma, marked by hyperphagia and rapid weight gain. Glucagon-like peptide-1 receptor agonists such as semaglutide have shown promising effects on weight reduction, but long-term data on weight outcomes, metabolic parameters and quality-of-life remain limited.
Four female patients with hypothalamic obesity following craniopharyngioma treatment received semaglutide for 24 months. Assessments included DXA scans, metabolic biomarkers, and The Three-Factor Eating Questionnaire at baseline, 6, 12, and 24 months. Interviews at 24 months explored hunger, side effects and quality of life.
After 24 months, median weight loss was 16% (95% CI: 8 to 34%, p = 0.004), with maximal loss of 17% at 6 months. Emotional and uncontrolled eating scores (range: 0-100) decreased by 44 (95% CI: - 69 to - 19, p = 0.011) and 27 units (95% CI: - 63 to 9, p = 0.097), respectively. Interviews revealed reduced hunger, improved self-confidence, less isolation, and higher productivity. Treatment was well tolerated; side effects were mainly mild GI symptoms. Fat and lean mass decreased by 10% (95% CI: 2 to 44%, p = 0.016) and 19% (95% CI: 14 to 26%, p < 0.001), respectively, with stable bone mineral content. Hemoglobin A1c and LDL cholesterol declined by 6.4 mmol/mol (95% CI: 2.3 to 9.9, p = 0.016) and 0.5 mmol/L (95% CI: 0.3 to 0.7, p = 0.012).
Semaglutide is a safe treatment that led to long-term sustained improvements in eating behavior, weight control, and improved metabolic health. Patients reported an improved quality of life, which persisted after body weight stabilization.
下丘脑性肥胖是颅咽管瘤的一种严重并发症，其特征为食欲亢进和体重迅速增加。胰高血糖素样肽-1受体激动剂（如司美格鲁肽）已显示出对体重减轻有显著效果，但关于体重结果、代谢参数和生活质量的长期数据仍然有限。
4例颅咽管瘤治疗后出现下丘脑性肥胖的女性患者接受司美格鲁肽治疗24个月。评估包括在基线、6个月、12个月和24个月时进行双能X线吸收测定扫描、代谢生物标志物检测以及三因素饮食问卷调查。在24个月时进行访谈，探讨饥饿感、副作用和生活质量。
24个月后，体重中位数下降了16%（95%置信区间：8%至34%，p = 0.004），6个月时体重下降最多达17%。情绪性进食和无节制进食得分（范围：0至100）分别下降了44分（95%置信区间：-69至-19，p = 0.011）和27分（95%置信区间：-63至9，p = 0.097）。访谈显示饥饿感减轻、自信心增强、孤独感减少且生产力提高。治疗耐受性良好；副作用主要为轻度胃肠道症状。脂肪量和瘦体重分别下降了10%（95%置信区间：2%至44%，p = 0.016）和19%（95%置信区间：14%至26%，p < 0.001），骨矿物质含量保持稳定。糖化血红蛋白和低密度脂蛋白胆固醇分别下降了6.4 mmol/mol（95%置信区间：2.3至9.9，p = 0.016）和0.5 mmol/L（95%置信区间：0.3至0.7，p = 0.012）。
司美格鲁肽是一种安全的治疗方法，可长期持续改善饮食行为、体重控制并改善代谢健康。患者报告生活质量有所提高，且在体重稳定后仍持续存在。
