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Cited by 146Pituitary Gland Disorders and TreatmentsRegulation of Appetite and ObesityHypothalamic control of reproductive hormones

Pathophysiology and Individualized Treatment of Hypothalamic Obesity Following Craniopharyngioma and Other Suprasellar Tumors: A Systematic Review

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van Iersel, Laura, Brokke, Karen E, Adan, Roger A H, Bulthuis, Lauren C M, van den Akker, Erica L T, van Santen, Hanneke M·2019·Endocrine Reviews
DOI 10.1210/er.2018-00017
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Abstract

The development of hypothalamic obesity (HO) following craniopharyngioma (CP) and other suprasellar tumors leads to reduced patient quality of life. No treatment algorithms are currently available for management of HO. Depending on which hypothalamic nuclei are destroyed, the pathophysiologic mechanisms and clinical symptoms that contribute to HO differ among patients. Herein, we review the contribution of the hypothalamus to the pathophysiologic mechanisms and symptoms underlying CP-associated HO. Additionally, we performed a systematic search of MEDLINE and Embase to identify all intervention studies for weight management in patients with CP or other suprasellar tumors published until September 2017. The search yielded 1866 publications, of which 40 were included. Of these 40 studies, we identified four modalities for intervention (i.e., lifestyle, dietary, pharmacotherapeutic, or surgical) within six clinical domains (i.e., psychosocial disorders, hyperphagia, sleep disturbances, decreased energy expenditure, hyperinsulinemia, and hypopituitarism). We used the findings from our systematic review, in addition to current knowledge on the pathophysiology of HO, to develop an evidence-based treatment algorithm for patients with HO caused by CP or other suprasellar tumors. Although the individual effects of the HO interventions were modest, beneficial individual effects may be achieved when the pathophysiologic background and correct clinical domain are considered. These two aspects can be combined in an individualized treatment algorithm with a stepwise approach for each clinical domain. Recently elucidated targets for HO intervention were also explored to improve future management of HO for patients with CP and other suprasellar tumors.

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  • Testosterone replacement in boys with hypogonadism increases muscle mass, which influences resting energy expenditure.

    “testosterone replacement in boys with hypogonadism increases muscle mass, which influences resting energy expenditure (32)”

    From Approach to the patient with acquired hypothalamic syndrome (2026) · cites this paper as [32]

    In “Interventions targeting hypopituitarism” (page unavailable), the review says testosterone replacement improves muscle mass in males, citing adult hypopituitarism guidelines; it separately says testosterone therapy induces puberty in boys. “Domain 6: hypopituitarism” (page unavailable) says testosterone influences resting energy expenditure by increasing muscle mass. The review does not specifically establish that replacement increases muscle mass in boys with hypogonadism. (LLM, conf=0.85)

    Experimental — accuracy not yet measured

  • Girls with craniopharyngiomas have lower bone mineral density than controls.

    “girls with craniopharyngiomas have lower bone mineral density than controls”

    From Approach to the patient with acquired hypothalamic syndrome (2026) · cites this paper as [32]

    The review’s “Domain 6: hypopituitarism” section says female patients with craniopharyngioma have considerably lower bone mineral density than matched population controls. It does not specify that the comparison was made in girls; the study cited for this finding concerns women with childhood-onset craniopharyngioma. (LLM, conf=0.85)

    Experimental — accuracy not yet measured

  • Currently available data suggest that nutrition interventions are not typically very effective for weight loss in hypothalamic obesity.

    “currently available data suggest that these are not typically very effective for weight loss (32)”

    From Approach to the patient with acquired hypothalamic syndrome (2026) · cites this paper as [32]

    The section on interventions targeting psychosocial disorders reports no beneficial weight effect in one rehabilitation setting, and Table 2 (labeled Conclusion in our copy) describes weight regain after a diet stopped. But Table 2 also reports substantial weight loss during that diet, and the passages do not establish that nutrition interventions are typically ineffective for weight loss in hypothalamic obesity. Page numbers are unavailable in our copy. (LLM, conf=0.72)

    Experimental — accuracy not yet measured

  • Lower bone mineral density in girls with craniopharyngiomas can be improved with timely initiation of estrogen.

    “this can be improved with timely initiation of estrogen”

    From Approach to the patient with acquired hypothalamic syndrome (2026) · cites this paper as [32]

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Sorted by citations

Authors
van Iersel, L., Brokke, K. E., Adan, R. A. H., Bulthuis, L. C. M., van den Akker, E. L. T., & van Santen, H. M.
Affiliations
  • Department of Pediatric Endocrinology, Wilhelmina Children’s Hospital, University Medical Center Utrecht, Utrecht, Netherlands
  • Utrecht University (NL)
  • University Medical Center Utrecht (NL)
  • Department of Pediatric Endocrinology, Erasmus MC–Sophia Children’s Hospital, Rotterdam, Netherlands
ORCID
Venue
Endocrine Reviews
Publisher
The Endocrine Society
Published
2018-09-20
Volume
40
Issue
1
Pages
193-235
ISSN
  • 0163-769X (ISSN-L)
  • 1945-7189
DOI
10.1210/er.2018-00017
OpenAlex
W2890877431
Cited by
146
References
34
Citations by year
2026: 17 · 2025: 21 · 2024: 27 · 2023: 17 · 2022: 30 · 2021: 13 · 2020: 16 · 2019: 5
FWCI
1.31
Type
journal article
Language
en
Open access
Locations
  • Endocrine Reviews (publishedVersion)
  • PubMed (publishedVersion)
  • EUR Research Repository (Erasmus University Rotterdam) (publishedVersion)
  • EUR Research Repository (Erasmus University Rotterdam) (submittedVersion)
  • Utrecht University Repository (Utrecht University) (submittedVersion, other-oa)
  • Utrecht University Repository (Utrecht University) (submittedVersion)
Funders
Santen
Topics
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Pituitary Gland Disorders and Treatments
  • Life Sciences › Neuroscience › Endocrine and Autonomic Systems › Regulation of Appetite and Obesity
  • Health Sciences › Medicine › Reproductive Medicine › Hypothalamic control of reproductive hormones
Keywords
hypothalamic obesity, craniopharyngioma, suprasellar tumor, weight management, hyperphagia, hypopituitarism, hyperinsulinemia, sleep disorders, energy expenditure, lifestyle intervention, dietary intervention, pharmacotherapy, surgical treatment, treatment algorithm, personalized treatment
MeSH terms
Craniopharyngioma, Humans, Hypothalamic Diseases, Obesity, Pituitary Neoplasms, Precision Medicine

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