Craniopharyngiomas and Peri-Pituitary Tumours

Tumours arising near to the pituitary gland can also affect pituitary function. These tumours include craniopharyngioma which is probably the most common and presents in younger patients from childhood, other conditions being epidermoid cysts, Ratke's pouch cysts etc.

At the time the condition presents, the symptoms have usually been present for some years. Visual impairment and headache are features of pituitary deficiency. In childhood it is also associated with growth failure and may also be a cause for squints. Presentation of raised intra-cranial pressure causing hydrocephalus is a serious condition requiring urgent therapy.

Investigation includes an endocrine assessment and also an MRI scan. The patient will require referral to a specialist unit. These cases usually require surgery by open craniotomy. Because of the location of the tumour, it is not always possible to achieve complete tumour removal and post-operatively radio-therapy may be required. These tumours may recur after surgery.

All of these patients require long-term care and follow-up, usually in a specialist unit. If patients suffer with hypopituitism they will require hormone replacement. In addition there may be problems due to hypothalamic dysfunction, obesity and diabetes insipidus which will require treatment. Steroid replacement will also be required. A presentation, particularly with hydrocephalus could be associated with more serious problems such as neurological disabilities and partial or complete loss of eye-sight. Multidisciplinary support and treatment is therefore, required in these cases.

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