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Craniopharyngioma increases risks for diabetes, all-cause mortality
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Adults with craniopharyngioma, whether onset was during childhood or adulthood, have increased risks for developing diabetes, new intracranial tumors, all-cause mortality, cardiovascular disease and cerebrovascular disease, study data show.
Kevin C.J. Yuen, MD, FRCP, FACE, associate professor medicine and medical director of the Barrow Neuroendocrinology Clinic at Barrow Neurological Institute in Pheonix, and colleagues evaluated data from KIMS, the Pfizer International Metabolic Database, on 1,669 adults with craniopharyngioma, either childhood-onset (diagnosed when aged < 18 years; n = 744) or adult-onset (diagnosed when aged 18 years; n = 925). Researchers sought to determine the relative risks of factors contributing to excess morbidity and mortality. Participants were enrolled between 1994 and 2012; time from entry to the last follow-up visit was a median 5.3 years.
The risks for CVD and cerebrovascular disease increased with older age at baseline, history of stroke and hyperlipidemia. Older age at baseline, greater waist circumference and higher baseline HbA1c levels increased the risk for developing new diabetes.
The risk for recurring craniopharyngioma was lower in women and those with previous surgery compared with no surgery and previous exposure to radiotherapy; the risk was higher in participants with adult-onset disease. The risk for developing new intracranial tumors was 3.5 times higher with radiotherapy (P = .067) and 2.3 times higher with older attained age with every 10 years from disease-onset.
All-cause mortality was inversely associated with insulin-like growth factor I standard deviation score measured at the last sampling before death or at the corresponding time from baseline if the participant was still alive (P = .0003); the rate was 27% lower with each unit higher IGF-I standard deviation score.
All participants, regardless of onset time, had increased risks for developing diabetes (9.3 times higher), new intracranial malignant tumors (8.1 times higher) and all-cause mortality (2.2 times higher) compared with the general population.
“Adults with both childhood and adult-onset craniopharyngioma have increased risks of morbidity and mortality, but conventional factors that increase the risks of cardio/cerebrovascular diseases, diabetes and new intra-cranial tumors in the general population play a greater role in increasing the risks in craniopharyngioma patients,” Yuen told Endocrine Today. “In addition, the lower the last IGF-I level measured before death, the greater the risk of death in these patients. Close long-term follow-up and early preventive management of modifiable CV risk factors in adults with craniopharyngioma are important management strategies for early detection of the tumor recurring and reduction of the risk of early death.” – by Amber Cox
For more information:
Kevin C.J. Yuen, MD, FRCP, FACE, can be reached at kevin.tuen@dignityhealth.org.
Disclosures: Yuen reports he is a current member of the KIMS Steering Committee; receives research grants from Novo Nordisk, OPKO Biologics, Pfizer, Teva Pharmaceuticals and Versartis; and serves on advisory boards for Novo Nordisk, Pfizer, Sandoz and Versartis. Please see the study for all other authors’ relevant financial disclosures.
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