Neuropediatrics 2006; 37 - P77
DOI: 10.1055/s-2006-974088

Melatonin treatment in obese patients with childhood craniopharyngioma and increased daytime sleepiness

U Gebhardt 1, A Emser 2, A Faldum 2, N Sörensen 3, G Handwerker 4 HL Müller 1, Studienkommission KRANIOPHARYNGEOM 2000
  • 1Klinik für Allgemeine Kinderheilkunde, Hämatologie/Onkologie, Klinikum Oldenburg gGmbH, Oldenburg, Germany
  • 2Institut für Biometrie, Epidemiologie und Biostatistik, Universitätsklinikum Mainz, Mainz, Germany
  • 3Neurochirurgische Universitätsklinik, Abteilung für Pädiatrische Neurochirurgie, Würzburg, Germany
  • 4Kinderarzt-Praxis, Passau, Germany

Childhood Craniopharyngioma (CP) is a rare dysontogenetic tumor. Patients frequently suffer from sleep disturbances and obesity due to hypothalamic lesions. A self-assessment daytime sleepiness questionnaire (Epworth Sleepiness Scale [ESS]) was used to evaluate 79 patients with CP. Because hypothalamic lesions may explain daytime sleepiness, salivary melatonin and cortisol concentrations were examined in severely obese (BMI>4SD) and non severely obese (BMI<4SD) CP patients (n=79), patients with hypothalamic pilocytic astrocytoma (n=19), and control subjects (n=30). Therapeutic effects of a melatonin substitution in patients with severe daytime sleepiness and disturbed melatonin secretion were analyzed.

Using a general linear model procedure analyzing the influence of BMI and tumor diagnosis on diurnal salivary melatonin we found that morning salivary melatonin levels were related to BMI (F test: p-value=0.004) and tumor diagnosis (F test: p-value=0.032). Also for nighttime salivary melatonin levels significant relations with BMI (p-value in F-test: <0.001) and tumor diagnosis (p-value in F-test: 0.025) were detectable. Melatonin concentrations in saliva of CP patients collected at nighttime or in the morning showed a negative correlation (Spearman's rho: –0.42; p=0.001; Spearman's rho: –0.31; p=0.020) with the patient's ESS score. Severely obese CP patients and severely obese hypothalamic tumor patients had similar patterns of melatonin secretion. As decreased nocturnal melatonin levels were associated with increased daytime sleepiness, BMI and hypothalamic tumor diagnosis, we initiated an experimental melatonin substitution in 10 adult obese CP patients (5f/5m). In all 10 patients the degree of daytime sleepiness significantly improved based on activity diaries, ESS and self- assessment questionnaires.

We speculate that hypothalamic lesions might be responsible for both obesity and daytime sleepiness. First experiences with melatonin substitution were promising.

Further studies are warranted and planned in KRANIOPHARYNGEOM 2007 (www.kraniopharyngeom.de).