Craniopharyngioma history and symptoms: Difference between revisions
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{{Craniopharyngioma}} | {{Craniopharyngioma}} | ||
{{CMG}}{{AE}}{{ | {{CMG}}{{AE}}{{Marjan}} | ||
==Overview== | |||
==Overview== | |||
Craniopharyngiomas are [[Tumor|slow growing]] and [[Symptom|symptoms]] often are present for a year or more before the [[diagnosis]] is established. A wide range of [[Symptom|symptoms]] may be present, depending upon the [[Craniopharyngioma MRI|precise location of the tumor]] and its relationship to [[Pituitary gland|adjacent normal structures]]. Most common symptoms of craniopharyngioma include [[headache]], [[nausea]], [[vomiting]], [[ataxia]], [[polyuria]], [[polydipsia]], [[stunted growth]], decreased [[libido]], [[amenorrhea]], [[weight gain]], [[myxedema]], [[vision loss]], [[Behavioral problems|behavioral and learning problems]]. | |||
==Symptoms== | ==Symptoms== | ||
Craniopharyngioma causes symptoms by:<ref>Symptoms of Craniopharyngioma. National library of Medicine. https://www.nlm.nih.gov/medlineplus/ency/article/000345.htm | Craniopharyngioma causes symptoms by''':'''<ref>Symptoms of Craniopharyngioma. National library of Medicine. https://www.nlm.nih.gov/medlineplus/ency/article/000345.htm</ref> | ||
*Increasing pressure on the brain | *[[Intracranial pressure|Increasing pressure on the brain]] usually from [[Hydrocephalus|obstructive]] [[hydrocephalus]]: <ref name="pmid10690718">{{cite journal |vauthors=Duff J, Meyer FB, Ilstrup DM, Laws ER, Schleck CD, Scheithauer BW |title=Long-term outcomes for surgically resected craniopharyngiomas |journal=Neurosurgery |volume=46 |issue=2 |pages=291–302; discussion 302–5 |date=February 2000 |pmid=10690718 |doi= |url=}}</ref> | ||
**Headache | **[[Headache]] | ||
**Nausea | **[[Nausea]] | ||
**Vomiting (especially in the morning) | **[[Vomiting]] (especially in the morning) | ||
**[[Ataxia]] | **[[Ataxia]] | ||
*Disrupting hormone production by the [[pituitary gland]] | *Disrupting hormone production by the [[pituitary gland]]: | ||
**[[Polyuria]] | **[[Polyuria]] | ||
**[[Polydipsia]] | **[[Polydipsia]] | ||
**Stunted growth, leading to [[short stature]] | **[[Stunted growth]], leading to [[short stature]] | ||
**Delayed [[puberty]] in children | **Delayed [[puberty]] in children | ||
**Decreased [[libido]] | **Decreased [[libido]] | ||
**[[Amenorrhea]] | **[[Amenorrhea]] | ||
**Weight gain | **[[Weight gain]] | ||
**[[Myxedema]] | **[[Myxedema]] | ||
* | *Pressure or damage to the [[optic nerve]]: <ref name="pmid10690718">{{cite journal |vauthors=Duff J, Meyer FB, Ilstrup DM, Laws ER, Schleck CD, Scheithauer BW |title=Long-term outcomes for surgically resected craniopharyngiomas |journal=Neurosurgery |volume=46 |issue=2 |pages=291–302; discussion 302–5 |date=February 2000 |pmid=10690718 |doi= |url=}}</ref> | ||
**Vision loss ([[bitemporal hemianopsia]]) | **[[Vision loss]] ([[bitemporal hemianopsia]]) <ref name="pmid23143722">{{cite journal |vauthors=Khan RB, Merchant TE, Boop FA, Sanford RA, Ledet D, Onar-Thomas A, Kun LE |title=Headaches in children with craniopharyngioma |journal=J. Child Neurol. |volume=28 |issue=12 |pages=1622–5 |date=December 2013 |pmid=23143722 |pmc=4264380 |doi=10.1177/0883073812464817 |url=}}</ref> | ||
**20% of children and 80% of adults with craniopharyngioma have visual defects | **20% of children and 80% of adults with craniopharyngioma have [[Visual|visual defects]]. | ||
**These defects are often | **These defects are often permanent, and may get worse after [[Surgery|surgical removal of the tumor]]. <ref name="pmid23143722">{{cite journal |vauthors=Khan RB, Merchant TE, Boop FA, Sanford RA, Ledet D, Onar-Thomas A, Kun LE |title=Headaches in children with craniopharyngioma |journal=J. Child Neurol. |volume=28 |issue=12 |pages=1622–5 |date=December 2013 |pmid=23143722 |pmc=4264380 |doi=10.1177/0883073812464817 |url=}}</ref> | ||
*Behavioral and learning problems may be present, due to [[frontal]] and [[temporal]] extension | *[[Behavioral problems|Behavioral and learning problems]] may be present, due to [[frontal lobe|frontal]] and [[temporal lobe|temporal]] extension | ||
===Visual symptoms=== | |||
*[[Visual system|Visual symptoms]] are frequent, and [[Visual acuity|deficits on formal ophthalmologic assessment]] are present in the majority of patients. <ref name="pmid10690718">{{cite journal |vauthors=Duff J, Meyer FB, Ilstrup DM, Laws ER, Schleck CD, Scheithauer BW |title=Long-term outcomes for surgically resected craniopharyngiomas |journal=Neurosurgery |volume=46 |issue=2 |pages=291–302; discussion 302–5 |date=February 2000 |pmid=10690718 |doi= |url=}}</ref> | |||
* [[ | *Symptoms can be a direct result of [[Bitemporal hemianopia|pressure on the optic chiasm]]. | ||
* [[ | *The specific deficit depends upon the [[Craniopharyngioma classification|growth pattern of the tumor]]. | ||
* [[ | ===Endocrine abnormalities=== | ||
* [[ | *Direct damage to or compression of normal structures can lead to a range of [[Endocrine system|endocrine abnormalities]]. | ||
* [[ | *Most frequently observed complications include [[Growth hormone|deficiencies of growth hormone]], [[gonadotropin]], [[Thyroid-stimulating hormone|thyroid stimulating hormone]], and [[adrenocorticotropic hormone]]. | ||
* [[ | *[[Diabetes insipidus]] is frequent when the [[Pituitary stalk|pituitary stalk is involved]]. <ref name="pmid23143722">{{cite journal |vauthors=Khan RB, Merchant TE, Boop FA, Sanford RA, Ledet D, Onar-Thomas A, Kun LE |title=Headaches in children with craniopharyngioma |journal=J. Child Neurol. |volume=28 |issue=12 |pages=1622–5 |date=December 2013 |pmid=23143722 |pmc=4264380 |doi=10.1177/0883073812464817 |url=}}</ref> | ||
* [[ | *[[Growth failure]], which can be caused by either [[hypothyroidism]] or [[growth hormone deficiency]]. | ||
* [[ | *[[Sexual dysfunction]] is the most common [[Endocrine|endocrine manifestation]] in adults. | ||
* [[ | *90% of men complain of [[erectile dysfunction]], while most women have [[amenorrhea]].<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> | ||
* [[ | ===Headache=== | ||
* [[ | *[[Headache|Headaches]] are present in approximately 50 percent of patients at the time of [[diagnosis]]. <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> | ||
* [[ | *Headaches may result from [[Traction (orthopedics)|traction]] on [[Dura mater|pain-sensitive structures]] by the [[tumor]] itself, [[Hydrocephalus|obstructive hydrocephalus]] from [[tumor]] [[Third ventricle|compression of the third ventricle]], or [[Meningism|meningeal irritation]] by [[Cyst|escaped cyst contents]].<ref name="pmid28325825">{{cite journal |vauthors=Wijnen M, van den Heuvel-Eibrink MM, Janssen JAMJL, Catsman-Berrevoets CE, Michiels EMC, van Veelen-Vincent MC, Dallenga AHG, van den Berge JH, van Rij CM, van der Lely AJ, Neggers SJCMM |title=Very long-term sequelae of craniopharyngioma |journal=Eur. J. Endocrinol. |volume=176 |issue=6 |pages=755–767 |date=June 2017 |pmid=28325825 |doi=10.1530/EJE-17-0044 |url=}}</ref> | ||
* [[ | ===Rare symptoms=== | ||
* [[ | *Craniopharyngiomas can also cause other generalized symptoms, such as [[depression]], [[Hormone|independent of any hormone deficiency]].<ref name="pmid10690718">{{cite journal |vauthors=Duff J, Meyer FB, Ilstrup DM, Laws ER, Schleck CD, Scheithauer BW |title=Long-term outcomes for surgically resected craniopharyngiomas |journal=Neurosurgery |volume=46 |issue=2 |pages=291–302; discussion 302–5 |date=February 2000 |pmid=10690718 |doi= |url=}}</ref> | ||
*The presumed cause is [[Tumor|extension of tumor]] into the [[Frontal lobe|frontal lobes]], [[Striatum|striatal]] and [[Thalamus|thalamic areas]], or [[limbic system]]. | |||
*[[Nausea and vomiting|Nausea]], [[Nausea and vomiting|vomiting]], and [[lethargy]] can accompany [[Headaches|pressure-related headaches]] in craniopharyngioma.<ref name="pmid23143722">{{cite journal |vauthors=Khan RB, Merchant TE, Boop FA, Sanford RA, Ledet D, Onar-Thomas A, Kun LE |title=Headaches in children with craniopharyngioma |journal=J. Child Neurol. |volume=28 |issue=12 |pages=1622–5 |date=December 2013 |pmid=23143722 |pmc=4264380 |doi=10.1177/0883073812464817 |url=}}</ref> | |||
==References== | ==References== | ||
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Marjan Khan M.B.B.S.[2]
Overview
Craniopharyngiomas are slow growing and symptoms often are present for a year or more before the diagnosis is established. A wide range of symptoms may be present, depending upon the precise location of the tumor and its relationship to adjacent normal structures. Most common symptoms of craniopharyngioma include headache, nausea, vomiting, ataxia, polyuria, polydipsia, stunted growth, decreased libido, amenorrhea, weight gain, myxedema, vision loss, behavioral and learning problems.
Symptoms
Craniopharyngioma causes symptoms by:[1]
- Increasing pressure on the brain usually from obstructive hydrocephalus: [2]
- Disrupting hormone production by the pituitary gland:
- Polyuria
- Polydipsia
- Stunted growth, leading to short stature
- Delayed puberty in children
- Decreased libido
- Amenorrhea
- Weight gain
- Myxedema
- Pressure or damage to the optic nerve: [2]
- Vision loss (bitemporal hemianopsia) [3]
- 20% of children and 80% of adults with craniopharyngioma have visual defects.
- These defects are often permanent, and may get worse after surgical removal of the tumor. [3]
- Behavioral and learning problems may be present, due to frontal and temporal extension
Visual symptoms
- Visual symptoms are frequent, and deficits on formal ophthalmologic assessment are present in the majority of patients. [2]
- Symptoms can be a direct result of pressure on the optic chiasm.
- The specific deficit depends upon the growth pattern of the tumor.
Endocrine abnormalities
- Direct damage to or compression of normal structures can lead to a range of endocrine abnormalities.
- Most frequently observed complications include deficiencies of growth hormone, gonadotropin, thyroid stimulating hormone, and adrenocorticotropic hormone.
- Diabetes insipidus is frequent when the pituitary stalk is involved. [3]
- Growth failure, which can be caused by either hypothyroidism or growth hormone deficiency.
- Sexual dysfunction is the most common endocrine manifestation in adults.
- 90% of men complain of erectile dysfunction, while most women have amenorrhea.[4]
Headache
- Headaches are present in approximately 50 percent of patients at the time of diagnosis. [5]
- Headaches may result from traction on pain-sensitive structures by the tumor itself, obstructive hydrocephalus from tumor compression of the third ventricle, or meningeal irritation by escaped cyst contents.[6]
Rare symptoms
- Craniopharyngiomas can also cause other generalized symptoms, such as depression, independent of any hormone deficiency.[2]
- The presumed cause is extension of tumor into the frontal lobes, striatal and thalamic areas, or limbic system.
- Nausea, vomiting, and lethargy can accompany pressure-related headaches in craniopharyngioma.[3]
References
- ↑ Symptoms of Craniopharyngioma. National library of Medicine. https://www.nlm.nih.gov/medlineplus/ency/article/000345.htm
- ↑ 2.0 2.1 2.2 2.3 Duff J, Meyer FB, Ilstrup DM, Laws ER, Schleck CD, Scheithauer BW (February 2000). "Long-term outcomes for surgically resected craniopharyngiomas". Neurosurgery. 46 (2): 291–302, discussion 302–5. PMID 10690718.
- ↑ 3.0 3.1 3.2 3.3 Khan RB, Merchant TE, Boop FA, Sanford RA, Ledet D, Onar-Thomas A, Kun LE (December 2013). "Headaches in children with craniopharyngioma". J. Child Neurol. 28 (12): 1622–5. doi:10.1177/0883073812464817. PMC 4264380. PMID 23143722.
- ↑ Cohen LE (August 2016). "Update on childhood craniopharyngiomas". Curr Opin Endocrinol Diabetes Obes. 23 (4): 339–44. doi:10.1097/MED.0000000000000264. PMID 27258775.
- ↑ Müller HL (June 2014). "Craniopharyngioma". Endocr. Rev. 35 (3): 513–43. doi:10.1210/er.2013-1115. PMID 24467716.
- ↑ Wijnen M, van den Heuvel-Eibrink MM, Janssen J, Catsman-Berrevoets CE, Michiels E, van Veelen-Vincent MC, Dallenga A, van den Berge JH, van Rij CM, van der Lely AJ, Neggers S (June 2017). "Very long-term sequelae of craniopharyngioma". Eur. J. Endocrinol. 176 (6): 755–767. doi:10.1530/EJE-17-0044. PMID 28325825. Vancouver style error: initials (help)