NS-22: ENDOCRINE SEQUELAE FOLLOWING SURGERY FOR HYPOTHALAMIC HAMARTOMAS WITH INTRACTABLE EPILEPSY

BACKGROUND: Surgery is performed rarely in patients with hypothalamic hamartomas, but a small number of patients require surgery for intractable epilepsy with much improved control. There is little published data about the endocrine outcome of such surgery. We have reviewed measures of endocrine function following surgery in these patients between Feb 2011 and Feb 2016 in a supra regional epilepsy surgery service in the UK. RESULTS: There were 7 patients (2 males). Results are given as median (range). Age at surgery was 12.1 years (3.7 to 17.6). Prior to surgery, height standard deviation score (SDS) was 0.7 (-0.5 to 1.0) and body mass index (BMI) SDS was 2.2 (-0.5 to 3.0). Five out of 7 patients were overweight (BMI SDS >1.75). After an observation period of 1.7 years (0.2 to 3.9) change in height SDS was 0 (-0.3 to 0.6) and change in BMI SDS 0.3 (-0.9 to 0.8). Four of 5 patients who were overweight before surgery remained overweight after surgery (BMI SDS range 1.8 to 3.8). The other patient reduced BMI SDS from +2 to 1.5. One of 2 lean patients became overweight following surgery. Acquired ACTH, TSH and gonadotropin deficiencies were seen in 2, 1 and 1 patient respectively. One patient acquired a disorder of thirst. CONCLUSIONS: 1. In this small, highly selected cohort of patients, resection of a hypothalamic hamartoma was not associated with accelerated weight gain. 2. Acquired hormone deficiencies were observed, highlighting the importance of careful pre-operative counselling and follow up.