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Dextroamphetamine Treatment in Children With Hypothalamic Obesity
INTRODUCTION: Hypothalamic obesity (HO) in children has severe health consequences. Lifestyle interventions are mostly insufficient and currently no drug treatment is approved for children with HO. Amphetamines are known for their stimulant side-effect on resting energy expenditure (REE) and suppres...
Autores principales: | , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Frontiers Media S.A.
2022
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8959487/ https://www.ncbi.nlm.nih.gov/pubmed/35355559 http://dx.doi.org/10.3389/fendo.2022.845937 |
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author | van Schaik, Jiska Welling, Mila S. de Groot, Corjan J. van Eck, Judith P. Juriaans, Alicia Burghard, Marcella Oude Ophuis, Sebastianus B. J. Bakker, Boudewijn Tissing, Wim J. E. Schouten-van Meeteren, Antoinette Y. N. van den Akker, Erica L. T. van Santen, Hanneke M. |
author_facet | van Schaik, Jiska Welling, Mila S. de Groot, Corjan J. van Eck, Judith P. Juriaans, Alicia Burghard, Marcella Oude Ophuis, Sebastianus B. J. Bakker, Boudewijn Tissing, Wim J. E. Schouten-van Meeteren, Antoinette Y. N. van den Akker, Erica L. T. van Santen, Hanneke M. |
author_sort | van Schaik, Jiska |
collection | PubMed |
description | INTRODUCTION: Hypothalamic obesity (HO) in children has severe health consequences. Lifestyle interventions are mostly insufficient and currently no drug treatment is approved for children with HO. Amphetamines are known for their stimulant side-effect on resting energy expenditure (REE) and suppressing of appetite. Earlier case series have shown positive effects of amphetamines on weight in children with acquired HO. We present our experiences with dextroamphetamine treatment in the, up to now, largest cohort of children with HO. METHODS: A retrospective cohort evaluation was performed of children with HO treated with dextroamphetamine at two academic endocrine pediatric clinics. Off-label use of dextroamphetamine was initiated in patients with progressive, therapy-resistant acquired or congenital HO. Anthropometrics, REE, self-reported (hyperphagic) behavior and energy level, and side effects were assessed at start and during treatment. RESULTS: Nineteen patients with a mean age of 12.3 ± 4.0 years had been treated with dextroamphetamine. In two patients, ΔBMI SDS could not be evaluated due to short treatment duration or the simultaneous start of extensive lifestyle treatment. Mean treatment duration of the 17 evaluated patients was 23.7 ± 12.7 months. Fourteen patients (n = 10 with acquired HO, n = 4 with congenital HO) responded by BMI decline or BMI stabilization (mean ΔBMI SDS of -0.6 ± 0.8, after a mean period of 22.4 ± 10.5 months). In three patients, BMI SDS increased (mean ΔBMI SDS of +0.5 ± 0.1, after a mean period of 29.7 ± 22.6 months). In 11 responders, measured REE divided by predicted REE increased with +8.9%. Thirteen patients (68.4%) reported decreased hyperphagia, improvement of energy level and/or behavior during treatment. Two patients developed hypertension during treatment, which resulted in dosage adjustment or discontinuation of treatment. Twelve children continued treatment at last moment of follow-up. CONCLUSION: In addition to supportive lifestyle interventions, dextroamphetamine treatment may improve BMI in children with HO. Furthermore, dextroamphetamines have the potential to decrease hyperphagia and improve resting energy expenditure, behavior, and energy level. In patients with acquired HO, these effects seem to be more pronounced when compared to patients with congenital HO. Future studies are needed to support these results. |
format | Online Article Text |
id | pubmed-8959487 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2022 |
publisher | Frontiers Media S.A. |
record_format | MEDLINE/PubMed |
spelling | pubmed-89594872022-03-29 Dextroamphetamine Treatment in Children With Hypothalamic Obesity van Schaik, Jiska Welling, Mila S. de Groot, Corjan J. van Eck, Judith P. Juriaans, Alicia Burghard, Marcella Oude Ophuis, Sebastianus B. J. Bakker, Boudewijn Tissing, Wim J. E. Schouten-van Meeteren, Antoinette Y. N. van den Akker, Erica L. T. van Santen, Hanneke M. Front Endocrinol (Lausanne) Endocrinology INTRODUCTION: Hypothalamic obesity (HO) in children has severe health consequences. Lifestyle interventions are mostly insufficient and currently no drug treatment is approved for children with HO. Amphetamines are known for their stimulant side-effect on resting energy expenditure (REE) and suppressing of appetite. Earlier case series have shown positive effects of amphetamines on weight in children with acquired HO. We present our experiences with dextroamphetamine treatment in the, up to now, largest cohort of children with HO. METHODS: A retrospective cohort evaluation was performed of children with HO treated with dextroamphetamine at two academic endocrine pediatric clinics. Off-label use of dextroamphetamine was initiated in patients with progressive, therapy-resistant acquired or congenital HO. Anthropometrics, REE, self-reported (hyperphagic) behavior and energy level, and side effects were assessed at start and during treatment. RESULTS: Nineteen patients with a mean age of 12.3 ± 4.0 years had been treated with dextroamphetamine. In two patients, ΔBMI SDS could not be evaluated due to short treatment duration or the simultaneous start of extensive lifestyle treatment. Mean treatment duration of the 17 evaluated patients was 23.7 ± 12.7 months. Fourteen patients (n = 10 with acquired HO, n = 4 with congenital HO) responded by BMI decline or BMI stabilization (mean ΔBMI SDS of -0.6 ± 0.8, after a mean period of 22.4 ± 10.5 months). In three patients, BMI SDS increased (mean ΔBMI SDS of +0.5 ± 0.1, after a mean period of 29.7 ± 22.6 months). In 11 responders, measured REE divided by predicted REE increased with +8.9%. Thirteen patients (68.4%) reported decreased hyperphagia, improvement of energy level and/or behavior during treatment. Two patients developed hypertension during treatment, which resulted in dosage adjustment or discontinuation of treatment. Twelve children continued treatment at last moment of follow-up. CONCLUSION: In addition to supportive lifestyle interventions, dextroamphetamine treatment may improve BMI in children with HO. Furthermore, dextroamphetamines have the potential to decrease hyperphagia and improve resting energy expenditure, behavior, and energy level. In patients with acquired HO, these effects seem to be more pronounced when compared to patients with congenital HO. Future studies are needed to support these results. Frontiers Media S.A. 2022-03-09 /pmc/articles/PMC8959487/ /pubmed/35355559 http://dx.doi.org/10.3389/fendo.2022.845937 Text en Copyright © 2022 van Schaik, Welling, de Groot, van Eck, Juriaans, Burghard, Oude Ophuis, Bakker, Tissing, Schouten-van Meeteren, van den Akker and van Santen https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms. |
spellingShingle | Endocrinology van Schaik, Jiska Welling, Mila S. de Groot, Corjan J. van Eck, Judith P. Juriaans, Alicia Burghard, Marcella Oude Ophuis, Sebastianus B. J. Bakker, Boudewijn Tissing, Wim J. E. Schouten-van Meeteren, Antoinette Y. N. van den Akker, Erica L. T. van Santen, Hanneke M. Dextroamphetamine Treatment in Children With Hypothalamic Obesity |
title | Dextroamphetamine Treatment in Children With Hypothalamic Obesity |
title_full | Dextroamphetamine Treatment in Children With Hypothalamic Obesity |
title_fullStr | Dextroamphetamine Treatment in Children With Hypothalamic Obesity |
title_full_unstemmed | Dextroamphetamine Treatment in Children With Hypothalamic Obesity |
title_short | Dextroamphetamine Treatment in Children With Hypothalamic Obesity |
title_sort | dextroamphetamine treatment in children with hypothalamic obesity |
topic | Endocrinology |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8959487/ https://www.ncbi.nlm.nih.gov/pubmed/35355559 http://dx.doi.org/10.3389/fendo.2022.845937 |
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