Craniofaringioma na infância e adolescência: repercussões endócrino-metabólicas

• Autor(a) principal: Hernandez, Patricia Debora Cavalcanti Tosta [UNIFESP]
• Data de Publicação: 2017
• Tipo de documento: Dissertação
• Idioma: por
• Título da fonte: Repositório Institucional da UNIFESP
• dARK ID: ark:/48912/001300000p092
• Texto Completo: https://sucupira.capes.gov.br/sucupira/public/consultas/coleta/trabalhoConclusao/viewTrabalhoConclusao.jsf?popup=true&id_trabalho=5199063; http://repositorio.unifesp.br/handle/11600/50374
• topic: Craniopharyngioma; Radiotherapy; Craniopharyngioma; Treatment; Adiposity; Abdominal fat; Growth hormone; Craniofaringioma; Radioterapia; Craniofaringioma; Terapia; Craniofaringioma; Complicações; Adiposidade; Gordura abdominal; Hormônio do crescimento

Objective: To evaluate the clinical and anthropometric characteristics and adiposity indexes of patients with craniopharyngioma and to correlate these parameters with the type of treatment performed, growth hormone deficiency (GHD), recombinant human growth hormone (rhGH) replacement therapy and adiposity at diagnosis. To analyze the risk factors associated with the evolution of obesity from diagnosis to the present moment. Methods: Fifty seven patients treated for craniopharyngioma underwent transversal evaluation (MAE) and survival analysis. Clinical characteristics, hormone replacement, type of treatment, anthropometric variables (Z score of weight and stature, at diagnosis and in MAE), adiposity indexes (Z BMI category at diagnosis and in MAE - overweight or obesity, percentage body fat (%BF), visceral and subcutaneous adipose tissue - VAT and SAT), criteria for metabolic syndrome (MS) were analysed by multiple regression and logistic models. The sample was divided according to GHD and rhGH replacement therapy: GHD with growth without GH, GHD using rhGH in MAE, GHD with prior rhGH use, GHD in programation of use rhGH and non-GHD. Survival analysis assessed the worsening of the Z BMI category according to adiposity indexes at diagnosis, treatment and rhGH replacement. Results: The medium age at diagnosis was 9.6 years-old and in MAE 16.6, 61.4% men. Surgery and radiotherapy (RT) was the most frequent combination of treatment (24/57; 42.1%) were treated with and 54/57 (94.7%) received at least two hormone replacements. Twenty-six of the 57 patients (45.6%) presented GHD with growth without GH. In the survival analysis, median time to worsening Z BMI category was 3.2 years after first treatment, with patients receiving both RT and α-interferon taking longer to worsen. Z BMI worsened equaly over time, regardless of the category at diagnosis. There was no influence of Z stature on Z BMI. The Z BMI at diagnosis worsened the Z BMI in the MAE (p=0.005). %BF was higher in patients with higher Z BMI at diagnosis (p <0.001) and %BF and VAT were lower in patients using rhGH in MAE (p <0.05). Obese patients at diagnosis presented more alteration in waist circumference (WC) (p=0.019) and more occurrence of MS (p=0.031). Conclusions: Patients with craniopharyngioma worsened the category of Z BMI with a median of 3.2 years after the first treatment. Regarding treatment, Z BMI category worsened less with α-interferon and RT use. Regardless of Z BMI category at diagnosis, there was an increase in Z BMI due to real weight gain, without height loss. The higher Z BMI at diagnosis, the higher the Z BMI and the %BF at the MAE. Replacement of rhGH at MAE had a beneficial effect on adiposity, decreasing %BF and VAT.