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PEDIATRICS Vol. 110 No. 6 December 2002, pp. e74

ELECTRONIC ARTICLE

Severe Hypersomnolence After Pituitary/Hypothalamic Surgery in Adolescents: Clinical Characteristics and Potential Mechanisms

Ayelet Snow, MD^*, Evelyne Gozal, PhD^||, Atul Malhotra, MD^¶, Dov Tiosano, MD, Rina Perlman, PhD, Céline Vega, PhD^||, Eli Shahar, MD, David Gozal, MD^||, Ze’ev Hochberg, MD and Giora Pillar, MD, PhD^*

^* Department of Pediatrics A and Sleep Laboratory
Pediatric Endocrinology
Pediatric Neurology Unit, Rambam Medical Center and Technion, Haifa, Israel
^|| Kosair Children’s Hospital Research Institute, University of Louisville, Louisville, Kentucky
^¶ Sleep Clinic, Harvard Medical School, Boston, Massachusetts

--> Objectives. After resection of hypothalamic/pituitary tumors, children are at risk for development of hormonal deficiencies, obesity, and hypersomnolence. However, the prevalence and pathophysiology of these complications are unclear. The purpose of this study was to assess the prevalence and severity of hypersomnolence in children after resection of pituitary tumors and to study the potential factors that contribute to this sleepiness if present. We further hypothesized that decrements in orexin levels may contribute to the sleepiness.

Methods. Six children who underwent hypothalamic/pituitary surgery were identified. Five of these patients and 5 matched control subjects underwent overnight polysomnography followed by a multiple sleep latency test. Children who had a primary sleep disorder (eg, obstructive sleep apnea) underwent treatment and were restudied subsequently (n = 2). Blood levels of pituitary hormones were measured. Blood and cerebrospinal fluid (CSF) were drawn from 4 patients and 3 control subjects to measure orexin levels.

Results. Endocrine control was appropriate in all children. Although patients had longer sleep duration but similar sleep efficiency than control subjects, relatively severe daytime somnolence was present (mean sleep latency: 10.3 ± 5.3 minutes vs 26.2 ± 1.1 minute in control subjects). Sleepiness did not correlate with body mass index or age. Furthermore, serum and CSF orexin levels did not differ between patients and control subjects.

Conclusions. Severe daytime sleepiness is frequent among children who undergo pituitary/hypothalamic surgery and does not seem to result from inappropriate cortisol or thyroxine replacement, disturbed nocturnal sleep, or low levels of orexin in the serum or CSF. We therefore speculate that other, unidentified neurohormonal mechanisms may mediate the excessive sleepiness of these patients.

Key Words: sleep • excessive daytime sleepiness • adolescents • orexin (hypocretin) • brain tumors • craniopharyngioma • OSA, obstructive sleep apnea • CPAP, continuous positive airway pressure • CSF, cerebrospinal fluid • ESS, Epworth Sleepiness Scale • FT4, free thyroxine • MSLT, multiple sleep latency test • TIB, time in bed • SL, sleep latency • REM, rapid eye movement • RIA, radioimmunoassay • BMI, body mass index • TST, total sleep time • GH, growth hormone

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Received for publication Apr 5, 2002; Accepted Jul 31, 2002.

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