Can GLP-1 help a 34-year-old with hypothalamic obesity?

Question

Hello doctor,

I am a 34-year-old woman diagnosed with hypothalamic obesity following surgery to remove a benign brain tumor (craniopharyngioma) three years ago. Due to surgery, I have gained over 50 pounds despite following a strict diet and exercise plan. My recent blood work shows elevated insulin levels and low T3, even though I am on thyroid hormone replacement therapy. I am currently taking Metformin, but it is only slightly helping with weight control, and I am still gaining. My endocrinologist has suggested trying a GLP-1 agonist to help manage the weight gain, but I am concerned about potential side effects.

Please help.

Answer 1

Hello,

Welcome to icliniq.com.

I understand your concern.

The weight gain following craniopharyngioma surgery occurs because the hypothalamus, which regulates hunger, satiety, and metabolism, has been affected. This leads to hyperphagia (increased appetite) and decreased energy expenditure, even when maintaining a strict diet and exercise. Elevated insulin levels reflect insulin hypersecretion, which is seen in hypothalamic obesity and contributes to weight gain. Metformin (Metabet), which you are already on, helps by improving insulin sensitivity and reducing hepatic glucose production.

GLP-1 (glucagon-like peptide-1) agonist, a hormone that slows gastric emptying, reduces appetite, and improves insulin sensitivity.

Side effects of GLP-1 agonists:

Nausea and vomiting.
Diarrhea or constipation.
Rarely, pancreatitis or gallbladder issues.
Mild headaches or dizziness.

Starting at a lower dose and gradually increasing it can help minimize adverse effects. Must manage your hypothyroidism carefully. Low T3 (triiodothyronine) levels, despite thyroid medicine, suggest that you may need a dose adjustment. Must get physically examined by an endocrinologist.

A high-protein, low-glycemic-index diet can help control hunger and stabilize blood sugar.

I hope this has helped you. Please feel free to reach out to me again in case of further queries.

Thank you.