Author(s): Schofield J.; Kalathil D.; Ahmad M.; Ahmad A.M.; Whittingham P.; Purewal T.S.; Sharma D.; Sinha A.
Source: Endocrine Reviews; Jun 2017; vol. 38 (no. 3)
Publication Date: Jun 2017
Publication Type(s): Conference Abstract
Abstract:Title A study of patients diagnosed with craniopharyngioma at a tertiary centre in the Merseyside Region, UK. Aims To characterise the patient population diagnosed with craniopharyngioma pre and post-treatment in a tertiary centre. Methods All patients with a diagnosis of craniopharyngioma treated at a tertiary centre in the Merseyside region over a 20 year period were included in the study. Patient demographics, presenting features and endocrine deficiencies were analysed, alongside treatment options and complications. Results Of the 23 patients diagnosed with Craniopharyngioma, 52% (12/23) were male. Mean age of diagnosis was 32 years (range 7 to 77 years). The first presenting symptom was headache in 57% (13/23) of patients, and visual loss in 57% (13/23) of patients. 13% (3/23) presented with neither of these symptoms. Of the known cases of pituitary hormone deficiency pre-treatment (n=8), 1 patient had panhypopituitarism, 1 had total anterior hypopituitarism and 1 had diabetes insipidus. There were 2 cases of partial hypopituitarism (>1 hormone deficiency) and 3 cases of single anterior hypopituitarism. Magnetic Resonant Imaging (MRI) showed that 57% (13/23) of patients had characteristic cystic changes and 52% (12/23) had suprasellar involvement. All patients underwent surgical intervention, which included total resection (n=2), subtotal resection (n=13) and stereotactic surgery with or without Ommaya shunting (n=9). The overall recurrence rate was 56.5% – 50% in total resection, 54% in subtotal resection and 75% in stereotactic surgery. All patients had hypopituitarism postoperatively. 43.4% had panhypopituitarism, 39.1% had total anterior hypopituitarism and 17.4% had partial hypopituitarism. Conclusion Craniopharyngiomas are rare, even in a tertiary setting. In this cohort of patients there does not appear to be an age or gender preponderance. The majority of patients presented with either headache or visual loss. Postsurgical hypopituitarism seems inevitable, and should be anticipated and investigated. Recurrence is a common complication, occurring in over half of all patients, regardless of treatment modality. Continued follow up of these patients is therefore essential.