Craniopharyngioma physical examination: Difference between revisions
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==Physical examination== | ==Physical examination== | ||
*Both general physical exam and neurological exam is indicated in suspected cases of craniopharyngioma. | *Both general physical exam and 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=== | ===General exam=== | ||
*Signs and symptoms may be related to various hormonal imbalances. | *Signs and symptoms may be related to 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==== | ====Hypothyroidism==== | ||
**Puffiness and non-pitting edema | **Puffiness and non-pitting edema | ||
| Line 22: | Line 22: | ||
====Cortisol deficiency==== | ====Cortisol deficiency==== | ||
**orthostatic hypotention | **orthostatic hypotention | ||
**Gastrointestinal symptoms, which include anorexia, nausea, and vomiting | **Gastrointestinal symptoms, which include 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 | **Weight loss | ||
**Hypoglycemia | **Hypoglycemia | ||
**Lethargy | **Lethargy | ||
**Confusion | **Confusion | ||
**Psychological disturbances such as psychosis and intolerance to stress | **Psychological disturbances such as psychosis and 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==== | ====Changes in volume and sodium control==== | ||
*Compression of the infundibulum can lead to the common presentation of diabetes insipidus. | *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: | *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 | **Hypovolemia | ||
**Decreased cardiac output | **Decreased cardiac output<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> | ||
**Decreased renal blood flow with azotemia | **Decreased renal blood flow with azotemia | ||
**Fatigue | **Fatigue | ||
| Line 40: | Line 40: | ||
===Neurologic examination=== | ===Neurologic examination=== | ||
*Visual field testing may reveal many patterns of visual loss but most frequently found visual problem is bitemporal hemianopsia. | *Visual field testing may reveal many patterns of visual loss but most frequently found 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 tracts. | *It results from the involvement compression of the optic chiasm and 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. | *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. | *Serial testing can be used in follow up to monitor 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 increased intracranial pressure which include horizontal double vision and papilledema should be checked for in any patient suspected of having an intracranial mass. | *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. | ||
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Overview
The diagnosis of craniopharyngioma is often made late after the initial appearance of symptoms. clinical picture at 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
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[3]
- 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 3.2 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.