Craniopharyngioma physical examination: Difference between revisions
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==Overview== | ==Overview== | ||
The [[diagnosis]] of craniopharyngioma is often made late after the [[Craniopharyngioma (patient information)|initial appearance of symptoms]]. The [[Craniopharyngioma (patient information)|clinical picture]] at the time of [[diagnosis]] often dominated by nonspecific manifestations of [[intracranial pressure]] like [[headache]], [[nausea and vomiting]]. Primary manifestations are [[visual impairment]] and [[Endocrine system|endocrine deficits]]. | |||
==Physical examination== | ==Physical examination== | ||
*Both [[Physical examination|general physical exam]] and [[Neurological examination|neurological exam]] is indicated in suspected cases of craniopharyngioma.<ref name="pmid27981519">{{cite journal |vauthors=Mortini P |title=Craniopharyngiomas: a life-changing tumor |journal=Endocrine |volume=57 |issue=2 |pages=191–192 |date=August 2017 |pmid=27981519 |doi=10.1007/s12020-016-1192-2 |url=}}</ref> | |||
===General exam=== | |||
*[[Medical sign|Signs]] and [[Symptom|symptoms]] may be related to [[Hormonal|various hormonal imbalances]].<ref name="pmid26574645">{{cite journal |vauthors=Müller HL |title=Craniopharyngioma and hypothalamic injury: latest insights into consequent eating disorders and obesity |journal=Curr Opin Endocrinol Diabetes Obes |volume=23 |issue=1 |pages=81–9 |date=February 2016 |pmid=26574645 |pmc=4700877 |doi=10.1097/MED.0000000000000214 |url=}}</ref> | |||
====Hypothyroidism==== | |||
*[[Myxedema|Puffiness and non-pitting edema]] | |||
*Slow return phase of [[Reflex|deep tendon reflexes]] | |||
*[[Hypoventilation]] and [[Cardiac output|decrease in cardiac output]] | |||
*[[Pleural effusions|Pericardial and pleural effusions]] | |||
*[[Constipation]] | |||
*[[Anemia]] | |||
*[[Cognition|Decreased mental function]] | |||
*[[Psychiatric|Psychiatric changes]] | |||
====Cortisol deficiency==== | |||
**[[Blood pressure|Orthostatic hypotention]] | |||
**Gastrointestinal symptoms which include [[Anorexia|anorexia,]] [[nausea and vomiting]].<ref name="pmid27258775">{{cite journal |vauthors=Cohen LE |title=Update on childhood craniopharyngiomas |journal=Curr Opin Endocrinol Diabetes Obes |volume=23 |issue=4 |pages=339–44 |date=August 2016 |pmid=27258775 |doi=10.1097/MED.0000000000000264 |url=}}</ref> | |||
**[[Weight loss]] | |||
**[[Hypoglycemia]] | |||
**[[Lethargy]] | |||
**[[Confusion]] | |||
**[[Psychological|Psychological disturbances]] such as [[psychosis]] and [[Stress (medicine)|intolerance to stress]].<ref name="pmid27981519">{{cite journal |vauthors=Mortini P |title=Craniopharyngiomas: a life-changing tumor |journal=Endocrine |volume=57 |issue=2 |pages=191–192 |date=August 2017 |pmid=27981519 |doi=10.1007/s12020-016-1192-2 |url=}}</ref> | |||
====Changes in volume and sodium control==== | |||
*Compression of the [[infundibulum]] can lead to the common presentation of [[diabetes insipidus]].<ref name="pmid28482426">{{cite journal |vauthors=Qi ST |title=[The status and prospects of craniopharyngioma] |language=Chinese |journal=Zhonghua Yi Xue Za Zhi |volume=97 |issue=17 |pages=1281–1282 |date=May 2017 |pmid=28482426 |doi=10.3760/cma.j.issn.0376-2491.2017.17.001 |url=}}</ref> | |||
*Other possible presentation in physical exam are:<ref name="pmid24467716">{{cite journal |vauthors=Müller HL |title=Craniopharyngioma |journal=Endocr. Rev. |volume=35 |issue=3 |pages=513–43 |date=June 2014 |pmid=24467716 |doi=10.1210/er.2013-1115 |url=}}</ref> | |||
**[[Hypovolemia]] | |||
**[[Cardiac output|Decreased cardiac output]] | |||
**Decreased [[renal blood flow]] with [[Acute kidney injury|azotemia]] | |||
**[[Fatigue]] | |||
**[[Weight loss]] | |||
**[[Cardiac arrhythmia|Cardiac arrhythmias]] due to [[hyperkalemia]] | |||
===Neurologic examination=== | |||
*[[Visual field]] testing may reveal many patterns of [[Vision loss|visual loss]] but most frequently found [[Bitemporal hemianopsia|visual problem is bitemporal hemianopsia]].<ref name="pmid28482426">{{cite journal |vauthors=Qi ST |title=[The status and prospects of craniopharyngioma] |language=Chinese |journal=Zhonghua Yi Xue Za Zhi |volume=97 |issue=17 |pages=1281–1282 |date=May 2017 |pmid=28482426 |doi=10.3760/cma.j.issn.0376-2491.2017.17.001 |url=}}</ref> | |||
*It results from the involvement compression of the [[optic chiasm]] and [[Tract (anatomy)|tracts]]. <ref name="pmid24467716">{{cite journal |vauthors=Müller HL |title=Craniopharyngioma |journal=Endocr. Rev. |volume=35 |issue=3 |pages=513–43 |date=June 2014 |pmid=24467716 |doi=10.1210/er.2013-1115 |url=}}</ref> | |||
*Formal [[visual field]] testing by [[ophthalmology]] is recommended as part of the initial work up. | |||
*[[Testing|Serial testing]] can be used in follow up to monitor [[Tumor|tumor growth or recurrence]].<ref name="pmid27258775">{{cite journal |vauthors=Cohen LE |title=Update on childhood craniopharyngiomas |journal=Curr Opin Endocrinol Diabetes Obes |volume=23 |issue=4 |pages=339–44 |date=August 2016 |pmid=27258775 |doi=10.1097/MED.0000000000000264 |url=}}</ref> | |||
*Signs of [[Intracranial pressure|increased intracranial pressure]] which include [[Diplopia|horizontal double vision]] and [[papilledema]] should be checked for in any patient suspected of having an [[Space occupying lesion|intracranial mass]]. | |||
==References== | ==References== | ||
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Overview
The diagnosis of craniopharyngioma is often made late after the initial appearance of symptoms. The clinical picture at the time of diagnosis often dominated by nonspecific manifestations of intracranial pressure like headache, nausea and vomiting. Primary manifestations are visual impairment and endocrine deficits.
Physical examination
- Both general physical exam and neurological exam is indicated in suspected cases of craniopharyngioma.[1]
General exam
- Signs and symptoms may be related to various hormonal imbalances.[2]
Hypothyroidism
- Puffiness and non-pitting edema
- Slow return phase of deep tendon reflexes
- Hypoventilation and decrease in cardiac output
- Pericardial and pleural effusions
- Constipation
- Anemia
- Decreased mental function
- Psychiatric changes
Cortisol deficiency
- Orthostatic hypotention
- Gastrointestinal symptoms which include anorexia, nausea and vomiting.[3]
- Weight loss
- Hypoglycemia
- Lethargy
- Confusion
- Psychological disturbances such as psychosis and intolerance to stress.[1]
Changes in volume and sodium control
- Compression of the infundibulum can lead to the common presentation of diabetes insipidus.[4]
- Other possible presentation in physical exam are:[5]
- Hypovolemia
- Decreased cardiac output
- Decreased renal blood flow with azotemia
- Fatigue
- Weight loss
- Cardiac arrhythmias due to hyperkalemia
Neurologic examination
- Visual field testing may reveal many patterns of visual loss but most frequently found visual problem is bitemporal hemianopsia.[4]
- It results from the involvement compression of the optic chiasm and tracts. [5]
- Formal visual field testing by ophthalmology is recommended as part of the initial work up.
- Serial testing can be used in follow up to monitor tumor growth or recurrence.[3]
- Signs of increased intracranial pressure which include horizontal double vision and papilledema should be checked for in any patient suspected of having an intracranial mass.
References
- ↑ 1.0 1.1 Mortini P (August 2017). "Craniopharyngiomas: a life-changing tumor". Endocrine. 57 (2): 191–192. doi:10.1007/s12020-016-1192-2. PMID 27981519.
- ↑ Müller HL (February 2016). "Craniopharyngioma and hypothalamic injury: latest insights into consequent eating disorders and obesity". Curr Opin Endocrinol Diabetes Obes. 23 (1): 81–9. doi:10.1097/MED.0000000000000214. PMC 4700877. PMID 26574645.
- ↑ 3.0 3.1 Cohen LE (August 2016). "Update on childhood craniopharyngiomas". Curr Opin Endocrinol Diabetes Obes. 23 (4): 339–44. doi:10.1097/MED.0000000000000264. PMID 27258775.
- ↑ 4.0 4.1 Qi ST (May 2017). "[The status and prospects of craniopharyngioma]". Zhonghua Yi Xue Za Zhi (in Chinese). 97 (17): 1281–1282. doi:10.3760/cma.j.issn.0376-2491.2017.17.001. PMID 28482426.
- ↑ 5.0 5.1 Müller HL (June 2014). "Craniopharyngioma". Endocr. Rev. 35 (3): 513–43. doi:10.1210/er.2013-1115. PMID 24467716.