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 [ESS]) 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 severely obese (BMI>or=4SD) and non severely obese (BMI<4SD)
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 BMI and
tumor diagnosis on diurnal salivary
melatonin we found that morning salivary
melatonin levels were related to BMI (F test: p-value=0.004) and
tumor diagnosis (F-test: p-value=0.032). Also for nighttime salivary
melatonin levels significant relations with BMI (p-value in F-test: <0.001) and
tumor diagnosis (p-value in F-test: 0.025) were detectable.
Melatonin concentrations in saliva of
craniopharyngioma patients collected at nighttime or in the morning showed a negative correlation (Spearman's rho: -0.42; p=0.001; Spearman's rho: -0.31; p=0.020) with the patient's ESS 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. As decreased nocturnal
melatonin levels were associated with increased
daytime sleepiness, BMI and
hypothalamic tumor diagnosis, we initiated an experimental
melatonin substitution in 10 adult obese patients (5f/5m) with childhood
craniopharyngioma. In all 10 patients with childhood
craniopharyngioma the degree of
daytime sleepiness significantly improved based on activity diaries, ESS, self assessment questionnaires and actimetry. We speculate that hypothalamic lesions might be responsible for both
obesity and
daytime sleepiness. As first experiences with experimental
melatonin substitution were promising, further randomized double-blinded studies on the beneficial effects of
melatonin substitution on
daytime sleepiness and weight control in these patients are warranted.