目的：患者下丘脑病理常发展为下丘脑肥胖，引起严重的代谢改变，导致发病率和死亡率增加。下丘脑肥胖的治疗方法尚未被证明非常有效，尽管胰高血糖素样肽-1受体激动剂semaglutide已被证明具有积极作用。我们研究了semaglutide对下丘脑肥胖患者体重减轻的影响。
方法：4例因颅咽管瘤治疗导致下丘脑肥胖的女性患者接受司马鲁肽治疗6个月。进行全身双能X线骨密度仪扫描，以及在基线和6个月后抽取的血液样本。随着体重和饮食行为的跟踪，塞马鲁肽的剂量每月增加(三因素饮食问卷，TFEQ-R18)。
结果：所有病例的BMI均降低，BMI的平均值为7.9（范围：6.7至10.1），相当于体重减轻17.0％（范围：11.3-22.4％）或20.2kg（范围为16.2kg至23.4kg）。我们发现总脂肪量有相当的减少(17.2%，p=0.006)和贫质量(16.0%，p=0.05)，而骨量不变(2.6%，p=0.12）。所有病例都报告了能量水平的增加，改善流动性和身体活动。治疗1个月后，不良饮食行为减少（情绪饮食-41分，p=0.02，不受控制的进食-23分，p=0.11）。HbA1c和总胆固醇显著降低(两者p=0.014)。
结论：塞马鲁肽是一种有前途且安全的HO治疗选择，改善饮食行为，减轻体重,并改善代谢标志物。
OBJECTIVE: Patients with hypothalamic pathology often develop hypothalamic obesity, causing severe metabolic alterations resulting in increased morbidity and mortality. Treatments for hypothalamic obesity have not proven very effective, although the glucagon-like peptide-1 receptor agonist semaglutide has been shown to have positive effects. We examined semaglutide\'s effect on weight loss in a sample of patients with hypothalamic obesity.
METHODS: Four female patients with hypothalamic obesity resulting from treatment of craniopharyngiomas were treated with semaglutide for six months. Whole Body Dual-energy x-ray absorptiometry scans were performed, and blood samples drawn at baseline and after six months. Semaglutide dosages were increased monthly along with tracking of body weight and eating behavior (Three Factor Eating Questionnaire, TFEQ-R18).
RESULTS: BMI was reduced in all cases, with an average of 7.9 BMI (range: 6.7 to 10.1) corresponding to a weight loss of 17.0% (range: 11.3-22.4%) or 20.2 kg (range 16.2 kg to 23.4 kg). We found a comparable reduction in total fat mass (17.2%, p = 0.006) and lean mass (16.0%, p = 0.05), whereas bone mass was unchanged (2.6%, p = 0.12). All cases reported an increase in energy levels, improved mobility and physical activity. Unfavorable eating behaviors were reduced after 1 month of treatment (emotional eating - 41 points, p = 0.02, uncontrolled eating - 23 points, p = 0.11). HbA1c and total cholesterol were significantly reduced (p = 0.014 for both).
CONCLUSIONS: Semaglutide is a promising and safe treatment option for HO, that improves eating behavior, reduces weight, and improves metabolic markers.
