Hunger, satiety, and eating behavior after craniopharyngioma - narrative review on current management and future therapeutic perspectives.

Craniopharyngiomas are low-grade, intracranial tumors frequently associated with dysfunction of the hypothalamic-pituitary axes and the development of obesity. This narrative review aimed to evaluate the potential contribution of eating behaviors, while also identifying perspectives for future therapeutic intervention. Searches were performed across five bibliographic databases. All peer-reviewed published studies involving childhood-onset or adult-onset craniopharyngioma populations were considered eligible when they examined eating behavior in relation to pharmacological or surgical interventions, neuroimaging, endocrine responses, energy expenditure, sleep, and/or neuropsychological outcomes. The available evidence regarding eating behavior in individuals with craniopharyngioma was limited, with only 10 of the 82 included studies employing validated measures of eating behavior. Eating behavior was assessed as a primary outcome in seven studies, as a secondary outcome in twelve studies, and discussed without formal measurement in thirty-one studies. Only one randomized controlled trial with the melanocortin-4 receptor (MC4R) agonist setmelanotide was identified that successfully targeted eating behavior (hyperphagia) modification and achieved significant weight loss as an intervention for craniopharyngioma-related obesity. Greater insight into eating behavior in this population, supported by long-term studies using validated assessment tools, is required to clarify the mechanisms underlying craniopharyngioma-associated obesity and confirm effectiveness and tolerability of medical treatment with MC4R-agonists.