Volume increase in craniopharyngiomas under growth hormone and/or sex hormones substitution: Role of tumors receptors or mere coincidence?
A young woman, aged 22, was referred to our department for a large craniopharyngioma. She was diagnosed at 12 years of age (in 2001), when she was noted to have severe short stature (−4 SD compared to children of the same age). At that time cerebral CT scan showed a totally calcified intra- and suprasellar mass measuring 45 × 17 × 15 mm suggesting a craniopharyngioma or a pituitary stone with thyreotroph,somatotroph and gonadotroph deficiencies. The vision was normal. As the pituitary lesion was totally calcified no intervention was performed. She was treated with Levothyroxine and had regular radiological monitoring by Magnetic Resonance Imaging (MRI). At 15 years old, as the tumor was stable, biosynthetic GH was prescribed. One year later GH was stopped because brain MRI revealed a solid, cystic and calcified tumor with discrete increase in its size. After stopping GH, the tumor remained stable, but pubertal development was lacking. At 17 years old, estrogens were introduced because of an important psychological impact of her hypogonadism. But, 4 months later, there was a rapid increase of the craniopharyngioma [] with intracranial hypertension that required a ventricular-peritoneal shunt.