Development of nonalcoholic fatty liver disease after treatment in patients 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 for 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 one 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 of NAFLD was 1.37±1.01 (range -0.75 to 3.18), with 4 (18.2%) patients being overweight and 9 (40.9%) being obese. BMI_Z increased above that at the time of the operation for 13 patients (68.4%) by 1.13 (range 0.10–2.84). Seventeen patients did not receive growth hormone. Insulin-like growth factor-I level < 3rd percentile was observed in 19 patients. Conclusion: NAFLD is common in survivors of co-craniopharyngioma and may develop earlier. If ALT or AST is above 40 IU/L, a diagnostic work-up should be started.