Treatment of Hypothalamic Obesity with Dextroamphetamine: A Case Series

Abstract

Background: A limited number of published case reports suggest a positive effect of dextroamphetamine, an adrenergic agonist affecting both the central nervous system (CNS) and peripheral nervous system, on physical activity and weight in patients with hypothalamic obesity (intractable obesity following CNS insult). Here, we present our clinical experience with dextroamphetamine treatment for hypothalamic obesity.

Methods: The clinical course of all patients started on dextroamphetamine treatment for severe hypothalamic obesity at our institution between 2010 and 2013 is reported. Dextroamphetamine administration was initiated at a single dose of 5 mg per day and titrated to effect up to a dose of 20 mg/day. BMI z-score velocity was calculated as change in BMI z-score over standardized intervals of 12 months. Parameters of treatment success and adverse events were assessed in a standardized fashion.

Results: Seven patients (2 males; mean age 17.6 years [range 12.9-24.5]) underwent individual treatment attempts with dextroamphetamine between 2010 and 2013. The primary diagnoses were craniopharyngioma (n = 4), ganglioglioma WHO I (n = 1), astrocytoma (n = 1), and neonatal meningitis (n = 1). Time from initial CNS insult to initiation of dextroamphetamine treatment averaged 5.2 years (range 2.4 months to 16.5 years). All patients demonstrated a steady increase in BMI z-score from the time of initial diagnosis until initiation of dextroamphetamine treatment. Mean baseline BMI z-score was +3.17 ± 0.93 (+1.9 to +4.4). Mean BMI z-score velocity decelerated to -0.18 ± 0.12 per year during the first year of treatment and stabilized at +0.05 ± 0.32 per year during the second year of treatment. No significant adverse events were reported.

Conclusion: Dextroamphetamine treatment led to stabilization or reduction of BMI z-score in a cohort of 7 patients with hypothalamic obesity, with no adverse effects. Considering the projected increase in BMI z-score according to the natural course of the disease, these findings are promising and warrant further study.

Keywords: Central nervous system stimulants; Craniopharyngioma; Dextroamphetamine; Hyperphagia; Hypothalamic obesity.

Fig. 1

Average BMI z-score velocity (see Methods) before and during the first, second, and third year of dextroamphetamine (dex) treatment in n = 7 patients with hypothalamic obesity. Error bars indicate standard deviations of the mean.

Fig. 2

BMI z-score velocity (see Methods) before and during the first, second, and third year of dextroamphetamine (dex) treatment in n = 7 patients with hypothalamic obesity grouped by diagnosis (n = 4 patients with craniopharyngioma, n = 3 patients with astrocytoma, ganglioglioma, meningococcal meningitis).

Fig. 3

BMI z-score velocity (see Methods) before and during the first, second, and third year of dextroamphetamine (dex) treatment in n = 7 patients with hypothalamic obesity grouped by the extent of hypothalamic involvement as indicated by the presence of central diabetes insipidus (CDI) (n = 4 patients with CDI, n = 3 patients without CDI).