Tohoku J. Exp. Med., 2019 November, 249(3)
Laparoscopic Sleeve Gastrectomy on Severe Obesity after Intracranial Germinoma Treatment: A Case Report
MASAHIRO NEZU,1,2 MASATAKA KUDO,1 YOSHIKIYO ONO,1 YUTA TEZUKA,1,3 RYO MORIMOTO,1 SHOJIRO SAWADA,4 HIROFUMI IMOTO,5 TAKESHI NAITOH,5 HIDEKI KATAGIRI,4 SADAYOSHI ITO1 and FUMITOSHI SATOH1,3
1Division of Nephrology, Endocrinology and Vascular Medicine, Tohoku University Hospital, Sendai, Miyagi, Japan
2Department of Endocrinology and Diabetes, Yamanashi Prefectural Central Hospital, Kofu, Yamanashi, Japan
3Department of Clinical Endocrinology and Metabolism, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
4Department of Diabetes and Metabolism, Tohoku University Hospital, Sendai, Miyagi, Japan
5Department of Surgery, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
Hypothalamic obesity is a clinical syndrome characterized by severe and refractory obesity that is caused by hypothalamic function impairment. Recently, bariatric surgery has been attempted for patients with hypothalamic obesity after craniopharyngioma, but experiences have not yet been accumulated in other hypothalamic disorders. Here, we report the case of a 39-year-old male patient with panhypopituitarism who received laparoscopic sleeve gastrectomy (LSG) after intracranial germinoma treatment. The patient was diagnosed with intracranial germinoma at age 15 and achieved complete remission after radiotherapy (total 50 Gy). He was obese during diagnosis [body mass index (BMI), 29.2 kg/m2], and his obesity gradually worsened after the intracranial germinoma treatment, and LSG was considered when his BMI was 48.6 kg/m2. After 1 month of hospitalized diet-exercise program, LSG was performed. After LSG, his BMI gradually decreased and reached 38.8 kg/m2 on the day of discharge (6 weeks after the surgery). Five months after LSG, his insulin resistance improved, but insulin hypersecretion remained. Fifteen months after the surgery, his BMI was 31.2 kg/m2, with marked decrease in visceral and subcutaneous fat areas (from 393.8 cm2 and 168.2 cm2 before the surgery to 111.5 cm2 and 56.3 cm2, respectively.). To our knowledge, this is the first case of LSG for hypothalamic obesity after intracranial germinoma treatment. Although the pathophysiology of hypothalamic obesity is different from that of primary obesity, LSG could be a successful therapeutic choice for patients with hypothalamic obesity after the intracranial germinoma treatment.
Keywords —— germinoma; higher brain dysfunction; hypopituitarism; hypothalamic obesity; laparoscopic sleeve gastrectomy
© 2019 Tohoku University Medical Press
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Tohoku J. Exp. Med., 2019, 249, 223-229
Correspondence: Masahiro Nezu, M.D., Ph.D., Division of Nephrology, Endocrinology and Vascular Medicine, Tohoku University Hospital, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi 980-8574, Japan.
e-mail: nezumasahiro@med.tohoku.ac.jp