Nonalcoholic fatty liver disease in long-term survivors of childhood-onset craniopharyngioma

Abstract

Purpose: Hypothalamic obesity in childhood-onset (CO-) craniopharyngioma patients may predispose to nonalcoholic fatty liver disease (NAFLD). This study reviewed the characteristics of NAFLD associated with CO-craniopharyngioma.

Methods: This study retrospectively reviewed 75 patients who underwent surgery for craniopharyngioma while younger than 15 years of age between 2000 and 2016.

Results: Elevated aspartate aminotransferase (AST) or alanine aminotransferase (ALT) above 40 IU/L was observed in 51 of the 75 (68%) CO-craniopharyngioma patients. Imaging studies were performed in 32 patients with elevated liver enzymes. The estimated prevalence of NAFLD in CO-craniopharyngioma was 47%. NAFLD was detected in 22 patients (male 59%, 4.3±4.0 years after first surgery). The mean age at the time of the initial operation was 9.1±2.9 years. Six patients (27.3%) were diagnosed within 1 year. Among the 19 patients with initial height and weight data, the body mass index (BMI) z-score (BMI_Z) at the time of diagnosis with NAFLD was 1.37±1.01 (range, -0.75 to 3.18), with 4 patients (18.2%) being overweight and 9 (40.9%) being obese. BMI_Z increased above BMI_Z at the time of the operation in 13 patients (68.4%). The increment in BMI_Z was 1.13 (range, 0.10-2.84). Seventeen patients did not receive growth hormone. An insulin-like growth factor-I level <3rd percentile was observed in 19 patients.

Conclusions: NAFLD is common in survivors of CO-craniopharyngioma and may develop earlier. If the ALT or AST is above 40 IU/L, a diagnostic work-up should be started.

Keywords: Child craniopharyngioma; Growth hormone deficiency; Hypothalamus; Nonalcoholic fatty liver disease; Obesity.

Fig. 1.

Study population. We reviewed 76 patients who had their first surgery before the age of 15 years from January 1, 2000 to February 1, 2016. Out of 75 patients, 32 underwent imaging studies because of elevated liver enzymes. Ultimately, 22 patients were diagnosed with NAFLD based on the imaging studies. The estimated prevalence of NAFLD in childhood onsetcraniopharyngioma was 46.8%. AST, aspartate aminotransferase; ALT, alanine aminotransferase; CT, computed tomography; NAFLD, nonalcoholic fatty liver disease.

Fig. 2.

Body mass index z-score (BMI_Z) change after initial operation. The red lines indicate the case who was given GH at NAFLD diagnosis. BMI_Z increased above BMI_Z at the time of the operation in 13 patients (68.4%). The mean increment in BMI_Z was 1.13 (range, 0.10–2.84). NAFLD, nonalcoholic fatty liver disease.

Fig. 3.

Height z-score (Height_Z) change after initial operation. The red lines indicate the case who was given GH at NAFLD diagnosis. The preoperative Height_Z was -1.17±0.87. NAFLD, nonalcoholic fatty liver disease.