Craniopharyngioma

What is craniopharyngioma?

Craniopharyngiomas are rare brain tumors that usually develop near the pituitary gland and hypothalamus. They are benign, slow growing tumors and rarely spread to other parts of the brain. However, the tumor can be very harmful due to the effect on nearby brain structures. Because of their location, craniopharyngiomas affect endocrine function and hormone levels. If the tumor compresses the optic nerve, vision may also be affected.

Childhood craniopharyngioma is most common in children ages 5-14 years. The tumor rarely occurs in children younger than 2 years old. Craniopharyngiomas account for about 6% of childhood brain tumors. There are about 100-120 cases of pediatric craniopharyngioma in the United States each year.

Treatments for craniopharyngioma include surgery, radiation therapy, or both. The goal of surgery is to completely remove the tumor or to remove a portion of the tumor to relieve symptoms prior to radiation therapy. Radiation therapy can be used alone or in combination with surgery.

The 10-year survival rate for craniopharyngioma is 80-90%. Because of possible long-term health problems, it is important for families to work closely with a multidisciplinary care team to support quality of life after craniopharyngioma.

Craniopharyngioma symptoms

Signs and symptoms of craniopharyngioma depend on the tumor size and location. Symptoms may include:

• Changes in hormones and endocrine function. This may result in problems such as slowed growth and delayed puberty.
• Vision problems or vision loss
• Headache
• Nausea and vomiting
• Decreased energy, fatigue
• Confusion
• Problems in thinking and learning
• Change in personality and behavior
• Increased thirst or urination, which may be caused by diabetes insipidus
• Low blood pressure
• Weight gain
• Increased or decreased appetite

Craniopharyngioma with hydrocephalus

Craniopharyngioma diagnosis

A diagnosis of craniopharyngioma starts with a physical exam, medical history, evaluation of symptoms, and sometimes blood tests. Doctors may then order an MRI or CT scan. Craniopharyngioma may be diagnosed based on imaging tests or analysis of tumor tissue or cyst fluid.

Specific medical tests to assist the diagnosis of craniopharyngioma may include:

• A physical exam and medical history help doctors learn about symptoms, general health, past illness, and risk factors.
• Blood and urine tests are used to measure substances in the blood including hormones, electrolytes, and tumor markers.
  • Hormones such as growth hormone, thyroid hormone, adrenocorticotropic hormone, and gonadotropins (hormones that control the release of sex hormones)
  • Blood and urine levels of electrolytes such as sodium, calcium, and potassium.
  • Urine output and concentration of urine (specific gravity) to test for diabetes insipidus.
  • Tumor markers, including alpha-fetoprotein (α-FP) and beta-human chorionic gonadotropin (β-hCG) to rule out the presence of a germ cell tumor, which may sometimes be confused with craniopharyngioma.
• A neurological exam examines the function of the brain, spinal cord, and nerves. These tests measure different aspects of functioning including memory, vision, hearing, muscle strength, balance, coordination, and reflexes.
• Imaging tests including computed tomography (CT) and magnetic resonance imaging (MRI) are used to help diagnose craniopharyngioma. Craniopharyngiomas are usually made up of a solid mass and fluid-filled cyst. The images also give information about the size and location of the tumor. MRI is often preferred, as it generally provides a clearer picture of brain tumors. CT may be used to look for cyst calcification, a common feature of pediatric craniopharyngioma. MRI and CT may be used to diagnose craniopharyngioma based on specific imaging characteristics of the solid and cystic components of the tumor.
• Analysis of the tumor tissue from a biopsy or surgery can confirm a diagnosis of craniopharyngioma. A pathologist looks at the tissue sample under a microscope to identify the specific type of tumor. As an alternative, tumor cyst fluid may be tested to assist in the diagnosis of craniopharyngioma.

Craniopharyngioma types

Craniopharyngiomas can be divided into 2 main types:

1. Adamantinomatous craniopharyngioma is the most common type of craniopharyngioma in children. These tumors are more irregularly shaped and usually have cysts and areas of calcification. A change in the CTNNB1 gene in cells of the tumor is often found.
2. Papillary craniopharyngioma is most common in adults and very rare in children. These tumors appear more solid and usually have a change in the BRAF gene in cells of the tumor.

There is no standard staging system for craniopharyngioma. The tumor is described as newly diagnosed or recurrent.

Craniopharyngioma prognosis

The 10-year survival rate for craniopharyngioma is about 80 to 90%. Craniopharyngiomas are benign and very rarely spread. However, these tumors can cause serious problems including changes in endocrine function and damage to the optic nerve. Therefore, it is important to consider long-term quality of life when planning treatments for craniopharyngioma.

Craniopharyngioma treatment

Treatments for craniopharyngioma include surgery and radiation therapy. Currently, there is no effective chemotherapy, and chemotherapy is rarely used to treat craniopharyngioma. Targeted therapy is being studied for some types of craniopharyngioma.

In most cases, the treatment approach for pediatric craniopharyngioma is less a decision of survival and more of quality of life. It is important that children be treated by an experienced medical team including specialists in radiation oncology, neurosurgery, endocrinology, neurology, and ophthalmology. Doctors should discuss the risks and benefits of each treatment so that families can make informed decisions.

Life after craniopharyngioma

Most survivors of craniopharyngioma live with complications that affect quality of life due to the tumor or its treatment. These problems may include:

• Endocrine system problems and abnormal hormone levels related to harm to the pituitary gland and hypothalamus
• Obesity
• Metabolic syndrome
• Diabetes insipidus
• Sleep disorders including excessive daytime sleepiness (EDS)
• Loss of vision
• Changes in personality, emotions, or behaviors
• Damage to blood vessels in the brain and disorders such as aneurysm and stroke
• Problems with learning and memory

Hormone imbalances after craniopharyngioma

Life after craniopharyngioma may include problems with the endocrine system. The endocrine system is a group of glands that make hormones to control many of the body’s functions such as growth, puberty, reproduction, metabolism, urine production, sleep, body temperature, emotions, and responses to stress.

Most problems after craniopharyngioma are related to abnormal hormone levels that are caused by damage to the pituitary gland or hypothalamus. Hormones that may be affected include growth hormone, thyroid-stimulating hormone (TSH), adrenocorticotropic hormone (ACTH), follicle-stimulating hormone (FSH), luteinizing hormone (LH), prolactin, and antidiuretic hormone (ADH). Hormone replacement therapy is often needed.

• Pituitary Disorders - The pituitary gland is called the “master gland” because it is responsible for many hormones and control of other glands. Abnormal pituitary function can lead to a number of problems including obesity, poor lipid profile, decreased bone mineral density, and fertility problems. These problems can occur even when the patient takes hormone replacement medicines.
• Hypothalamus Disorders - Damage to the hypothalamus also results in hormone changes that affect quality of life. These problems include increased appetite and weight gain leading to the development of severe obesity. Changes in behavior and emotions are also common, and patients may have mood swings, loss of interest in activities, social withdrawal, and fatigue.

Obesity after craniopharyngioma

Craniopharyngioma often causes hypothalamic obesity, extreme weight gain caused by damage to the hypothalamus. This is likely due to a complex interaction of factors including changes in metabolism (fewer calories burned at rest), increased appetite, and low physical activity levels. Obesity can occur even when patients don’t eat more than normal. It is hard to treat hypothalamic obesity, and it can be frustrating for patients, families, and doctors. Obesity increases risk for heart disease, diabetes, stroke, and metabolic syndrome as well as poor physical function, joint problems, and low fitness levels. This makes healthy habits like good nutrition and physical activity even more important for quality of life in craniopharyngioma survivors.

Metabolic syndrome after childhood craniopharyngioma

Metabolic syndrome is a common health issue that affects quality of life and longevity for survivors of childhood craniopharyngioma. This syndrome is a group of conditions that include obesity, high blood pressure, high blood sugar levels, high triglyceride levels, and low HDL levels (good cholesterol). Metabolic syndrome is linked to heart disease, stroke, and diabetes.

Sleep problems after craniopharyngioma

Sleep disorders such as excessive daytime sleepiness are common among craniopharyngioma survivors. This is often due to damage to the hypothalamus. A sleep disorder can contribute to symptoms such as fatigue, emotional and behavioral problems, and problems with learning or memory. Feeling tired also makes it hard to eat healthy or be physically active, which can lead to further health problems. It is important for patients to have healthy sleep habits and seek help if a sleep disorder is suspected.

Brain health after craniopharyngioma

Treatments for craniopharyngioma, including surgery and radiation therapy, can affect long-term brain health. Craniopharyngioma survivors are often at higher risk of developing problems in blood vessels of the brain. These changes can sometimes lead to ischemia or stroke. Patients are also at increased risk for seizures. Cognitive problems (cognitive late effects) may occur in children with craniopharyngioma. Classroom accommodations and school support services can help students and families cope with any educational challenges.

Quality of life after craniopharyngioma: tips for families

Although most children with craniopharyngioma survive their disease, long-term effects are common. There are things patients and families can do to help promote quality of life:

• Seek help from a multidisciplinary care team. Children with craniopharyngioma need ongoing medical care to monitor disease progression, evaluate hormone levels and function, and manage health problems. Patients can also benefit from psychosocial support during treatment and survivorship. Care team members from psychology, child life, social work, and other disciplines can assist with coping and adjustment concerns including risk for social isolation, depression, and cognitive problems.
• Encourage healthy eating and exercise. A healthy diet and regular physical activity are important to reduce weight gain, decrease risk for health problems such as heart disease and diabetes, and promote quality of life and physical function. These habits can also help improve sleep and learning. The emotional and behavioral effects of craniopharyngioma can also create extra challenges for patients and families. A nutrition professional can help families plan nutritious meals and snacks, find strategies to help control hunger, and develop healthy eating habits. A licensed rehabilitation provider or a certified fitness professional can help plan exercise adapted to a patient’s specific health needs.
• Promote good sleep habits. Sleep disorders are common in cancer survivors, especially after craniopharyngioma. Ways to cope with excessive daytime sleepiness include scheduling naps, increasing physical activity, and school accommodations. A doctor may prescribe medicine to help with alertness or recommend cognitive behavioral therapy to improve sleep habits and develop coping skills. A healthy sleep routine can help to improve sleep quality and alertness.

More: life after brain tumors