Therapieansätze bei hypothalamer Adipositas

Zusammenfassung

Die Pathogenese der hypothalamen Adipositas ist vielfältig und beinhaltet neben der Hyperphagie auch einen vermindertem Grundumsatz, autonome Fehlregulationen als auch Schlafstörungen und eine verminderte Mobilität. Resultierend daraus existieren verschiedene Therapiekonzepte. Bisher konnte jedoch weder für den konservativ-medikamentösen Ansatz als auch für den bariatrisch-chirurgischen Therapieansatz eine allgemeingültige Empfehlung gegeben werden. Am vorliegenden Fallbericht möchten wir noch einmal die Komplexität der Erkrankungen und die Schwierigkeit sinnvoller Therapieentscheidungen darstellen.

Summary

The pathogenesis of hypothalamic obesity is complex. It includes in addition to hyperphagia a diminished basal metabolic rate, autonomic dysregulation, sleep disturbances and decreased mobility. This fact has resulted in various therapeutic strategies. To date, however, a general treatment concept or recommendation does not exist, neither for the conservative medical approach nor for bariatric surgery. With this case report we want to point out the complexity of the disorder as well as the challenge of establishing effective therapeutic decisions.

Schlüsselwörter

Hypothalame Adipositas - bariatrische Operation

Keywords

Hypothalamic obesity - bariatric surgery

• Literatur

• 1 Bereket A, Kiess W, Lustig RH. et al. Hypothalamic obesity in children. Obes Rev 2012; 13: 780-798.
• 2 Bingham NC, Rose SR, Inge TH. Front Endocrinol (Lausanne). Bariatric surgery in hypothalamic obesity 2012; 3: 23
• 3 Danielsson P, Janson A, Norgren S, Marcus C. Impact sibutramine therapy in children with hypothalamic obesity or obesity with aggravating syndromes. J Clin Endocrinol Metab 2007; 92: 4101-4106.
• 4 Deepak D, Furlong NJ, Wilding JP, MacFarlane IA. Cardiovascular disease, hypertension, dyslipidaemia and obesity in patients with hypothalamic-pituitary disease. Postgrad Med J 2007; 83: 277-280.
• 5 Fernandes JK, Klein MJ, Ater JL. et al. Triiodothyronine supplementation for hypothalamic obesity. Metabolism 2002; 51: 1381-1383.
• 6 Greenway FL, Bray GA. Treatment of hypothalamic obesity with caffeine and ephedrine. Endocr Pract 2008; 14: 697-703.
• 7 Ismail D, O’Connell MA, Zacharin MR. Dexamphetamine use for management of obesity and hypersomnolence following hypothalamic injury. J Pediatr Endocrinol Metab 2006; 19: 129-134.
• 8 Kim JH, Choi JH. Pathophysiology and clinical characteristics of hypothalamic obesity in children and adolescents. Ann Pediatr Endocrinol Metab 2013; 18: 161-167.
• 9 Kubik JF, Gill RS, Laffin M, Karmali S. The impact of bariatric surgery on psychological health. J Obes 2013;. 2013: 837989
• 10 Lennerz BS, Wabitsch M, Lippert H. et al. Bariatric surgery in adolescents and young adults - safety and effectiveness in a cohort of 345 patients. Int J Obes (Lond) 2014; 38: 334-340.
• 11 Luque RM, Kineman RD. Impact of obesity on the growth hormone axis: evidence for a direct inhibitory effect of hyperinsulinemia on pituitary function. Endocrinology 2006; 147: 2754-2763.
• 12 Lustig RH, Rose SR, Burghen GA. et al. Hypothalamic obesity caused by cranial insult in children: altered glucose and insulin dynamics and reversal by a somatostatin agonist. J Pediatr 1999; 135 (2 Pt 1) 162-168.
• 13 Lustig RH, Post SR, Srivannaboon K. et al. Risk factors for the development of obesity in children surviving brain tumors. J Clin Endocrinol Metab 2003; 88: 611-616.
• 14 Müller HL, Gebhardt U, Wessel V. et al. First experiences with laparoscopic adjustable gastric banding (LAGB) in the treatment of patients with childhood craniopharyngioma and morbid obesity. Klin Pediatr 2007; 219: 323-325.
• 15 Skorzewska A, Lal S, Waserman J, Guyda H. Abnormal food-seeking behavior after surgery for craniopharyngioma. Neuropsychobiology 1989; 21: 17-20.
• 16 Till H, Blüher S, Hirsch W, Kiess W. Efficacy of laparoscopic sleeve gastrectomy (LSG) as a stand-alone technique for children with morbid obesity. Obes Surg 2008; 18: 1047-1049.