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An unusual suspect causing behavioural problems and pituitary failure in a child
Adam Charles Heathcote1, Justin Conrad Rosen Wormald, Richard Stocks
1Norwich Medical School, University of East Anglia, Norwich, Norfolk, UK.
BMJ Case Reports
|December 18, 2012
Summary
A boy with autism and ADHD developed severe feeding issues due to non-malignant germ-cell tumors affecting his pituitary gland. Treatment involved radiotherapy and hormone replacement.
Area of Science:
- Pediatric Endocrinology
- Neuro-oncology
- Developmental Neuroscience
Background:
- Autistic Spectrum Disorder (ASD) and Attention Deficit Hyperactivity Disorder (ADHD) can present with feeding and behavioral issues.
- Disinhibited behavior and severe food refusal in adolescents may be misattributed to psychogenic causes.
- Eating disorder facilities may not always identify underlying organic pathologies.
Observation:
- A 9-year-old boy with diagnosed ASD and ADHD exhibited feeding and behavioral problems.
- By age 11, he developed disinhibition and severe oral food refusal, leading to inpatient eating disorder treatment.
- Persistent vomiting and minimal intake necessitated further medical investigation.
Findings:
- Hypovolemic hypernatremia indicated severe dehydration.
- MRI revealed multiple tumor masses with suprasellar and pituitary involvement.
- Histology confirmed primary, non-malignant germ-cell tumors.
Implications:
- This case highlights the importance of considering organic causes, such as brain tumors, in patients with severe feeding refusal and behavioral changes, even with prior neurodevelopmental diagnoses.
- Early identification and treatment of pituitary tumors are crucial to prevent severe metabolic derangements and long-term complications.
- Multidisciplinary management involving neuro-oncology, endocrinology, and behavioral specialists is essential for optimal outcomes in complex pediatric cases.
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