Neuroendocrine Characteristics In Patients With Craniopharyngioma:Relative To Tumor Growth Pattern

Part Ⅰ Hypopituitarism mode in patients with craniopharyngioma:Relative to tumor growth patternPurpose:To summary the imaging features,intraoperative course of 293 patients operated on for craniopharyngiomas with different size,component,and locations,a distinct classification of craniopharyngiomas was advocated.To understand the pituitary and target hormone change rules in different types of craniopharyngioma and analyzed the difference of postoperative long-term effect.To explore the optimal operation strategy,and to continuous improve the quality of life post operation.Methods:The clinical data of 293 patients who underwent primary microsurgery for craniopharyngiomas at our institute was analysed retrospectively between 1998 and 2012.A topographic classification of the tumor was applied based on their relationships with the sellar diaphragm,the stalk and the floor of the third ventricle(3rdVF).The originated site,clinical and surgical characteristic,endocrine outcome and quality of life in each group of patients were noted and the factors related to them were analyzed.Results:Three basic growth patterns as type Q)Infra-diaphragmatic;type S)Supra-Diaphragmatic inter-arachnoidal extra-ventricular;and Type T)Infundibulotuberal growths were found based on neuroimaging and intraoperative findings.Tumor’s growth pattern was highly relevant both to patient demographic and pathological aspects.There were obvious difference in age,location of tumor,clinical symptoms,tumor size and texture,the relationship between tumor and pituitary stalk.There were no significant difference in gender andIn endocrine,hypothalamus-pituitary-adrenal(HPA)axis,hypothalamic--pituitary-thyroid(HPT)axis,hypothalamic-pituitary-gonadal(HPG)axis,growth hormone(GH),prolactin(PRL)and diabetes insipidus(DI)had different degrees of abnormities before and after operation,and they were impacted by surgery to different extent.The abnormal rate is 31.7-64.8%before operation but 41.0-75.4%in the late postoperative period.The rates of new abnormalities range from 31.9%to 71.9%and the improvement rates are between 0 and 28.6%.Obvious rises in the abnormal rates are detected only in HPA,HPT and GH between the preoperative period and the late postoperative period(p<0.05).the normal rate of the group with preserved PSs is higher than that of the patients whose PSs were resected.Neuroendocrine hormone replacement therapy:glucocorticoid replacement therapy rate were greater than the rate of deficiency adrenal function,thyroid hormone replacement therapy and the rate of functional damage rate is basically the same,antidiuretic hormone replacement therapy was significantly lower than the rate in patients with diabetes insipidus.There were no gonadal hormone and growth hormone replacement therapy,the proportion of two or more combined hormone replacement therapy were accounted for 63.4%.The tumor removal was total in 90.8%(92.1%for type Q,96.2%for type S,and 87.6%for type T),subtotal in 9.2%(7.9%for type Q,3.8%for type S,and 12.4%for type T),The functional outcome results were good recovery or mild disability in 76%for type Q,92%for type S and 67%for type T,respectively.Patients with type T tumor group had significantly worse functional status compared with the type Q and type S tumor groups(p = 0.001).The overall survival rate was 96.1%at 2 years,90.5%at 5 years,87.3%at 10 years.The progress-free survival rate was 90.6%at 2 years,88.6%at 5 years,and 82.2%at 10 years.There was significant difference in progress-free survival between groups,patients with type T tumor had a significant difference in progress-free survival between groups,patients with type T tumor had a significantly lower probability of recurrence-free survival than those with orther types tumor.Conclusion:1、Most patients with craniopharyngioma appeared different degree of hypopituitary,which is further aggravated postoperative.The endocrine hormone disorder types are complex,endocrine monitoring and appropriate target hormone replacement therapy is necessary after surgery.2、The formidable treatment status of craniopharyngioma indicated that hierarchical therapeutic strategy might be necessary according to the tumor’s growth pattern.hierarchical comparison is necessary when comparing the outcomes and survivals across treatment paradigms in patients,which is also conducive to the different stages of monitoring patients(before and after operation,postoperative years)state the endocrine function,and provide clinical data necessary for further follow-up and treatment.3、Gross-total resection of craniopharyngioma makes positive contribution to the improvement of long-term survival,tumor progression-free rate and quality of life.4、The regularity of diabetes insipidus may be influenceby pituitary stalk protection directly in early postoperative,typical triphasic diabetes insipidus will be appear in patients whose PS was resected,but in patients whose PS is intact,there is no prior to and after diabetes insipidus cases appear,and it is directly into the hyponatremia,which is needed to pay attention to prevent cerebral edema.5、The patients whose PSs were resected for the need of radical treatment,have a low recurrence rate,and show no significant differences in metabolism and quality of life with the patients with their PSs preserved.Part Ⅱ Clinical observation of application and safety of insulin tolerance test in patients with craniopharyngiomasPurpose:To evaluate the practical value and safety of the insulin tolerance test(ITT)in adult patients with craniopharyngioma.Methods A total of 120 adult patients with craniopharyngioma admitted from 2006 to 2012 were involved in this study.All patients underwent the ITT test.The reaction to hypoglycemia,changes in blood pressure and heart rate,and other vital signs were observed in the process of clinical investigation.Results All the 120 subjects completed the trial,based on the provocation test,the result of 76 cases(63.3%)was negative.Peak GH responses were different between the groups(F=3.094,P=0.000).The lowest peak GH was in craniopharyngioma group and the highest peak GH was in meningioma.Conclusion ITT test can reflect the different the hypothalamic-pituitary growth hormone and corticosteroids axis function of craniopharyngioma.There was a highly significant correlation between peak GH values and IGF-1、BMI value.When ITT is carried out in carefully selected patients with craniopharyngioma\,it is a safe and reliable clinical diagnostic test.Peak GH responses were different between the groups.The lowest peak GH was in type Q and The highest peak GH was in type S.Patients with an appropriate clinical history and either the presence of at least three PHDs or serum IGF-I much less than normal do not require GH stimulation testing for the diagnosis of adult GHD.