Pediatric Laboratory Medicine

Toronto, Canada

Pediatric Laboratory Medicine

Toronto, Canada
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O'Gorman C.S.,University of Toronto | O'Gorman C.S.,University of Limerick | Simoneau-Roy J.,University of Toronto | Simoneau-Roy J.,Université de Sherbrooke | And 13 more authors.
Journal of Clinical Endocrinology and Metabolism | Year: 2010

Context: Retrospective studies suggest that adolescents with craniopharygnioma and hypothalamic obesity have increased sleep-disordered breathing (SDB). Objectives: The objectives of this study were to compare the prevalence of SDB in adolescents with craniopharyngioma-related obesity compared with body mass index (BMI)-matched controls and to explore possible relationships between SDB, insulin resistance, and adipocytokines. Design: This was a cross-sectional study of obese craniopharyngioma and obese control adolescents. Setting: Subjects were evaluated in the clinical investigation unit at the Hospital for Sick Children, Toronto. Patients: Fifteen patients with craniopharyngioma-related obesity and 15 BMI-matched controls were recruited and tested. Interventions: Each subject underwent fasting blood work, frequent sampled iv glucose tolerance test, polysomnography, and abdominal magnetic resonance imaging with calculation of visceral and sc adipose tissue. Main Outcome Measures: Main measures included insulin sensitivity, sleep efficiency, and fragmentation. Results: Insulin sensitivitywaslower in craniopharyngioma subjectscomparedwith control subjects (0.96 ± 0.34 vs. 1.67 ± 0.7, P = 0.01). Sleep-onset latency (19.3 ± 27.8 vs. 31.9 ± 23.4, P = 0.03) and oxygen saturations (rapid eye movement sleep: 89.0 ± 5.1 vs. 94.2 ± 2.3, P < 0.001; non-rapid eye movementsleep: 88.4 ± 5.6 vs. 94.3 ± 1.5, P < 0.001) were lower in craniopharyngioma. Obstructive apnea-hypopnea index (OAHI) (7.5 ± 9.0 vs. 1.5 ± 1.5, P = 0.03) was higher in craniopharyngioma. Respiratory distress index and OAHI correlated negatively with adiponectin concentrations (r = -0.61, P = 0.03, r = -0.71, P = 0.006, respectively) in craniopharyngioma. On multiple regression, TNF-α and craniopharyngioma were independent positive predictors of sleep-onset latency and adiponectin and craniopharyngioma were significant predictors (negative and positive, respectively) of OAHI. Conclusions: SDB is increased in adolescents with craniopharyngioma-related obesity compared with BMI-matched controls. Routine polysomnography should be considered in obese patients with craniopharyngioma and appropriate treatment initiated. Copyright © 2010 by The Endocrine Society.


O'Gorman C.S.,Hospital for Sick Children | O'Gorman C.S.,Hospital for Sick Children Research Institute | O'Gorman C.S.,University of Limerick | Simoneau-Roy J.,Hospital for Sick Children | And 8 more authors.
International Journal of Pediatric Obesity | Year: 2011

Ghrelin, released from the stomach, acts at the hypothalamus and is associated with initiation of food intake. We hypothesised that patients with craniopharyngioma and hypothalamic obesity (CRHO) would have ghrelin abnormalities. Fifteen CRHO patients and 15 BMI-matched controls underwent oral glucose tolerance test with dynamic ghrelin measurement. From 030 minutes, ghrelin (pg/ml) decreased less (43.4 ± 38.8 vs. 70.8 ± 35.8, p < 0.05) and insulin (pmol/l) increased more (1 669.2 ± 861.7 vs. 1 049.1 ± 560.4, p = 0.04) in CRHO compared with controls, respectively. Insulin area-under-the-curve was a weak negative predictor of the 030 minutes ghrelin decrease (r2 = 0.29, p = 0.02). Delayed ghrelin suppression may contribute to obesity in CRHO. © 2011 Informa Healthcare.

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