Craniopharyngioma is a rare dysontogenetic benign
tumor. Patients frequently suffer from endocrine deficiencies, sleep disturbances, and
obesity due to pituitary and hypothalamic lesions. A self-assessment
daytime sleepiness questionnaire (German version of the Epworth
Sleepiness Scale) was used to evaluate 79 patients with childhood
craniopharyngioma. Because hypothalamic lesions may explain
daytime sleepiness in
craniopharyngioma patients, salivary
melatonin and
cortisol concentrations were examined in obese and nonobese
craniopharyngioma patients (n = 79), patients with hypothalamic
pilocytic astrocytoma (n = 19), and control subjects (
n = 30). Using a general linear model procedure analyzing the influence of body mass index (BMI) and
tumor diagnosis on diurnal salivary
melatonin, we found that morning salivary
melatonin levels were related to BMI (by F test, P = 0.004) and
tumor diagnosis (by F test, P = 0.032). Also for nighttime salivary
melatonin levels significant relations with BMI (by F test, P < 0.001) and
tumor diagnosis (by F test, P = 0.025) were detectable.
Melatonin concentrations in saliva of
craniopharyngioma patients collected at night or in the morning showed a negative correlation (night: Spearman's rho = -0.42; P = 0.001; morning: Spearman's rho = -0.31; P = 0.020) with the patient's Epworth
Sleepiness Scale score. Severely obese
craniopharyngioma patients and severely obese
hypothalamic tumor patients had similar patterns of
melatonin secretion. Differences in terms of diurnal salivary
cortisol concentrations were not detectable when patient groups and controls were compared. We speculate that hypothalamic lesions might be responsible for both
obesity and
daytime sleepiness. As decreased nocturnal
melatonin levels were associated with increased
daytime sleepiness, BMI, and
hypothalamic tumor diagnosis, further studies on the beneficial effects of
melatonin substitution on
daytime sleepiness and weight control in these patients are warranted.