Risk factors for mortality caused by hypothalamic obesity in children with hypothalamic tumours

Abstract

BackgroundHypothalamic obesity (HyOb) is a common complication of childhood hypothalamic tumours. Patients with HyOb probably have a higher mortality rate than those with other types of obesity due in many cases to obstructive sleep apnoea/hypoventilation. ObjectivesTo identify predictive factors for mortality caused by HyOb in children. MethodsTwenty children with HyOb secondary to hypothalamic tumours that were followed-up for 3 years and aged <15 years at diagnosis, and received supraphysiological glucocorticoid treatment for 1 month. ResultsMean age at diagnosis was 6.363.60 years. Mean body mass index (BMI) Standard deviation of the samples (SDS) increased from 0.77 +/- 1.26 to 2.66 +/- 1.45 during the first 6 months, but slowed from month 6-12 (2.73 +/- 1.35). BMI SDS at 0-6 months was significantly higher in patients aged <6 years at diagnosis than in those aged >6 years at diagnosis (3.71 +/- 1.96 vs. 0.83 +/- 0.73, P<0.001). Maximum BMI SDS was also significantly higher in the younger group (3.88 +/- 1.39 vs. 2.79 +/- 0.64, P<0.05). In all, four patients died and the mortality rate was significantly higher in the patients with a further increase in BMI SDS>1 SDS after 6 months of therapy (RR: 8.4, P<0.05). Both overall mortality and obesity-related mortality rates were higher in the patients aged <6 years at diagnosis (4.5-fold, 7.2-fold higher, respectively, P>0.05). The mortality rate was also 3.7-fold higher in the patients with a maximum BMI SDS3 at any time during the first 3 years after therapy(P>0.05). ConclusionsAn increase in BMI SDS after 6 months of therapy was observed to be a risk factor for mortality caused by HyOb. In addition, age <6 years at diagnosis and a maximum BMI SDS3 were associated with a higher mortality rate, indicating that earlier and more aggressive treatment of obesity is required.