Intracranial Lesions in Children and Adolescents with Morbid Obesity

Abstract

Background: Intracranial lesions may affect the hypothalamo-hypophyseal axis and lead to some neuro-endocrinological dysfunctions (hyperphagia, sleep disorders and hormonal dysfunctions). There is a very limited number of studies about childhood obesity and intracranial lesions. Aims: To evaluate the incidence of intracranial lesions and its role in clinical symptoms and aetiology in cases with morbid obesity who have been admitted to the paediatric endocrinology department with this complaint. Study Design: Cross-sectional study. Methods: A total of 120 cases admitted to the paediatric endocrinology department with the complaint of morbid obesity between 2002 and 2015 were included in this study. A detailed history was taken and a physical examination was performed; biochemical, hormonal parameters were evaluated. Contrast dynamic magnetic resonance imaging was performed in order to visualize cranial pathologies. Results: An intracranial lesions was detected in 16.6% of the patients and 55% of these lesions were adenoma of the hypophysis. Prolactin levels were increased in six patients but front hypophyseal hormone levels were within normal range in the rest of the patients. Growth velocity of the patients was not affected. Conclusion: In our study, the incidence of intracranial lesions in children and adolescents with morbid obesity was much higher than in the normal population.   According to this data, we are of the opinion that contrast dynamic magnetic resonance imaging is helpful in children with morbid obesity for the early detection of the mass before it causes any clinical or neurological symptoms and in the prevention of future complications.

Keywords

• Intracranial lesions, children, morbid obesity, magnetic resonance imaging

Kaynakça

1. 1. Alemzadeh R, Rising R, Lifshitz F. Obesity in children. In: Lifshitz F, editor. Obesity, Diabetes Mellitus, Insulin resistance and Hypoglycemia. USA, New York: Informa Helathcare 2007:1-36
2. 2. Bereket A, Kiess W, Lustig RH, Muller HL, Goldstone AP, Weiss R, et al. Etiology and Pathophysiology Hypothalamic obesity in children. Obes Rev 2012;13:780-98.
3. 3. Keil MF, Stratakis CA. Pituitary tumors in childhood: an update in their diagnosis, treatment and molecular genetics. Expert Rev Neurother 2008;8:563-74.
4. 4. Kim BS, Illes J, Kaplan RT, Reiss A, Atlas SW. Incidental findings on pediatric MR images of the brain. AJNR Am J Neuroradiol 2002;23:1674- 7.
5. 5. Barlow SE; Expert Committee. Expert committee recommendations regarding the prevention, assessment, and treatment of childhood and adolescent overweight and obesity: summary report. Pediatrics 2007;120(Suppl 4):164-92.
6. 6. Kurtoğlu S, Hatipoğlu N, Mazıcıoğlu M, Kendirci M, Keskin M, Kondolot M. Insulin resistance in obese children and adolescents: HOMA-IR cut-off levels in the prepubertal and pubertal periods. J Clin Res Pediatr Endocrinol 2010;2:100-6.
7. 7. Craig ME, Jefferies C, Dabelea D, Balde N, Seth A, Donaghue KC; International Society for Pediatric and Adolescent Diabetes. ISPAD Clinical Practice Consensus Guidelines 2014 Compendium Definition, epidemiology, and classification of diabetes in children and adolescents. Pediatr Diabetes 2014;15(Suppl 20):4-17.
8. 8. Brook GDC, Dattani MT. Handbook of Clinical Pediatric Endocrinology. Wiley Blackwell, 2012:337-42.

9. 9. Sari S, Sari E, Akgun V, Ozcan E, Ince S, Saldir M, et al. Measures of pituitary gland and stalk: from neonate to adolescence. J Pediatr Endocrinol Metab 2014;27:1071-6.
10. 10. Önal H, Adal E, Ercan O. Çocuk Endokrinolojisinde normaller ve referanslar. In: Cinaz P, Darendereliler F, Akıncı A, Özkan B, Dündar B, Abacı A, et al. editors. Çocuk Endokrinolojisi. Nobel Tıp Kitabevi, 2014: 833-946.
11. 11. Wilne S, Collier J, Kennedy C, Koller K, Grundy R, Walker D. Presentation of childhood CNS tumors: a systematic review and meta-analysis. Lancet Oncol 2007;8:685-95.
12. 12. Deopujari CE, Kumar S, Karmarkar VS, Biyani NK, Mhatre M, Shah J. Pediatric suprasellar lesions. J Pediatr Neurosci 2011;6(Suppl 1):S46-55.
13. 13. Kopeleman PG, Weaver JV, Noonan K. Abnormal hypothalamic function and altered insulin secretion and IGFBP-1 binding in obesity. Int J Obes 1990;14:75-9.
14. 14. Lusting R, Weiss R. Disorders of energy balance. In: Sperling M(ed). Pediatric Endocrinology. Saunders Elsevier Inc. Philadelphia USA 2008:788-838.
15. 15. Taylor M, Couto-Silva AC, Adan L, Trivin C, Sainte-Rose C, Zerah M, et al. Hypothalamo- pituitary Lesions in Pediatric Patients: Endocrine Symptoms Often Precede Neuro-ophthalmic Presenting Symptoms. J Pediatr 2012;161:855-63.