Craniopharyngioma

A craniopharyngioma is a rare type of brain tumor derived from pituitary gland embryonic tissue that occurs most commonly in children, but also affects adults. It may present at any age, even in the prenatal and neonatal periods, but peak incidence rates are childhood-onset at 5–14 years and adult-onset at 50–74 years. People may present with bitemporal inferior quadrantanopia leading to bitemporal hemianopsia, as the tumor may compress the optic chiasm. It has a point prevalence around two per 1,000,000. Craniopharyngiomas are distinct from Rathke's cleft tumours and intrasellar arachnoid cysts. Craniopharyngiomas are almost always benign. However, as with many brain tumors, their treatment can be difficult, and significant morbidities are associated with both the tumor and treatment. Headache (obstructive hydrocephalus) Hypersomnia Myxedema Postsurgical weight gain Polydipsia Polyuria (diabetes insipidus) Vision loss (bitemporal hemianopia) Vomiting Often occurs after treatment Growth hormone (GH) insufficiency, caused by the reduction in GH production - symptoms include: Stunted growth and delayed puberty (in children) General fatigue, loss of muscle mass and tone (in adults) Pituitary insufficiency Often occurs to some degree because craniopharyngiomas develop in the area of the pituitary stalk, which can affect the function of the pituitary gland and many other hormones Reduction in prolactin production is very uncommon and occurs with severe pituitary insufficiency. Large pituitary tumors can paradoxically elevate blood prolactin levels due to the "stalk effect". This elevation occurs as a result of the compression of the pituitary stalk, which interferes with the brain's control of prolactin production. In premenopausal women, elevated prolactin can lead to reduction or loss of menstrual periods and/or breast milk production (galactorrhea). With stalk effect, prolactin levels are usually only slightly elevated, as opposed to prolactinomas in which the prolactin level is usually very high.