Endocrine dysfunction and complications in patients with post-operative Craniopharyngioma: A Narrative Review

Abstract

Craniopharyngioma is a rare benign epithelial tumor arising in the sellar and suprasellar region that frequently involves the hypothalamic-pituitary axis. Although advances in neurosurgical techniques and adjuvant therapies have substantially improved survival, endocrine dysfunction remains one of the most important determinants of long-term morbidity and impaired quality of life. Endocrine abnormalities may be present at diagnosis due to tumor-related hypothalamic and pituitary compression or develop following surgery and radiotherapy.

Common postoperative complications include central diabetes insipidus, syndrome of inappropriate antidiuretic hormone secretion, cerebral salt wasting, hypothalamic obesity, and deficiencies of growth hormone, adrenocorticotropic hormone, thyroid-stimulating hormone, and gonadotropins. These disorders contribute to impaired growth, delayed puberty, infertility, metabolic syndrome, cardiovascular disease, neurocognitive impairment, and reduced quality of life. Early recognition, systematic endocrine surveillance, and timely hormone replacement therapy are essential to minimize morbidity. Recent advances in hypothalamus-sparing surgery, endoscopic approaches, proton beam radiotherapy, and molecularly targeted therapy offer opportunities to improve functional outcomes while maintaining effective tumor control.This narrative review summarizes the current understanding of the mechanisms underlying endocrine dysfunction in craniopharyngioma, reviews the spectrum of postoperative endocrine complications and their long-term consequences, and discusses strategies for endocrine surveillance, hormone replacement, and multidisciplinary management.