MON-101 - Amenorrhea and Obesity as Presenting Features of Adamantinomatous Craniopharyngioma: Case Report

Introduction
Craniopharyngiomas are rare epithelial tumors arising from remnants of Rathke’s pouch, with heterogeneous clinical presentations depending on involvement of the hypothalamic–pituitary region. Although more common in children, they may occur in adults and present with subtle endocrine and metabolic manifestations (1-3).
Case presentation
A 27-year-old woman with a history of Graves’ disease treated with radioactive iodine and subsequent levothyroxine replacement presented with two years of amenorrhea and progressive weight gain of 30 kg. Her BMI was 32.4 kg/m². Physical examination revealed central obesity, round face, and pink striae. Thyroid function tests were normal. Prolactin was mildly elevated within the non-adenomatous range. Serum cortisol, urinary free cortisol, and IGF-1 were normal. Estradiol levels were low with inappropriately normal gonadotropins, consistent with hypogonadotropic hypogonadism.
Pituitary MRI demonstrated a suprasellar cystic mass measuring 8.5 × 15.5 × 13.5 mm posterior to the pituitary stalk, with a liquid–liquid interface, focal calcification, and mild optic chiasm compression, compatible with adamantinomatous craniopharyngioma. Visual field testing showed mild asymmetric defects. Initial conservative management was chosen; however, interval growth to 19 × 17 × 14 mm prompted surgical resection. Histopathology confirmed adamantinomatous craniopharyngioma. Postoperative complications included hydrocephalus, cerebrospinal fluid fistula, diabetes insipidus, and adrenal insufficiency.

Discussion
Craniopharyngiomas are classified into adamantinomatous and papillary subtypes. Clinical manifestations depend on mass effect and hypothalamic–pituitary involvement. In this case, hypogonadism and obesity were partly related to hypothalamic dysfunction. Hypothalamic obesity results from disruption of nuclei regulating energy homeostasis, appetite, and satiety, leading to reduced energy expenditure, autonomic dysfunction, and hyperphagia. Hypothalamic obesity results from disruption of nuclei regulating energy homeostasis, appetite, and satiety, leading to reduced energy expenditure, autonomic dysfunction, and hyperphagia (4,5).

Conclusions
Craniopharyngiomas are rare in adults and may present with obesity and hypogonadism, especially in the presence of hypothalamic involvement, warranting evaluation for central etiologies.

References
1.Apps JR, Müller HL, Hankinson TC, et al. Endocr Rev. 2023;44:518–538.
2.Müller HL, Merchant TE, Warmuth-Metz M, et al. Nat Rev Dis Primers. 2019;5:75.
3.Piloni M, Gagliardi F, Bailo M, et al. Adv Exp Med Biol. 2023;1405:299–329.
4.Van Iersel L, Brokke KE, Adan RAH, et al. Endocr Rev. 2019;40:193–235.
5.Argente J, Farooqi IS, Chowen JA, et al. Lancet Diabetes Endocrinol. 2025;13:57–68

*Unless otherwise noted, all abstracts presented at ENDO must not be released to the press or the public until the date and time of presentation. For oral presentations, the abstracts are embargoed until the session begins. The Endocrine Society reserves the right to lift the embargo on specific abstracts that are selected for promotion prior to or during ENDO.*