Pediatric hypothalamic lipoma with hypothermia--case report

Hypothalamic Lipoma: Outcome of an Intracranial Developmental Lesion

Background

Hypothalamic lipomas are benign developmental lesions that tend to be discovered incidentally. This article describes the radiological features, outcome, and the postulated theories behind hypothalamic lipomas development.

Methods

The electronic archive of neurosurgery was retrospectively reviewed. All patients with a neuroradiological diagnosis of hypothalamic lipoma, between 2005 and 2020, were included.

Results

Out of 246 patients with intracranial lipomas, a total of six patients with hypothalamic lipomas have been identified. On computed tomography images, one of the hypothalamic lipomas demonstrated calcification. On magnetic resonance imaging, peripheral enhancement after contrast administration was noted in one of the lesions. Considering the benign nature of the lesions, neurosurgical intervention was not indicated.

Conclusion

The majority of patients with hypothalamic lipomas are asymptomatic and undergo brain imaging for other indications. Although uncommon, such developmental lesions can be identified in the general population, especially with the advancement of neuroimaging techniques.

Hypothalamic lipoma and growth hormone deficiency

Background

Intracranial lipomas are rare, congenital lesions, most often located at the midline. Most hypothalamic lipomas are asymptomatic, but some cases have been associated with precocious puberty, hypothermia, headache and/or obesity.

Case presentation

A 7-year-old boy was referred for short stature and proved to be partially growth-hormone deficient. Magnetic resonance imaging (MRI) revealed a lipoma in the paramedian hypothalamus. Growth hormone treatment resulted in swift and uncomplicated catch-up growth.

Conclusions

The present case appears to be the first to link hypothalamic lipoma to GH deficiency. The neuro-endocrine pathophysiology underpinning this link remains to be explored.

Magnetic resonance imaging of sellar and juxtasellar abnormalities in the paediatric population: an imaging review

The sellar and juxtasellar regions in the paediatric population are complex both anatomically and pathologically, with magnetic resonance imaging (MRI) being the "gold standard" imaging modality due to the high contrast of detail. Assessment requires a detailed understanding of the anatomy, embryology, pathophysiology and normal signal characteristics of the pituitary gland and surrounding structures in order to appropriately characterise abnormalities. This article aims to provide an overview of the imaging characteristics of developmental/congenital and acquired disease processes which affect the sellar and juxtasellar region in the paediatric population. Main Messages • The sellar region is anatomically complex and covers a wide pathology spectrum. • MRI is the key imaging modality to assess sellar and juxtasellar pathology. • Numerous developmental anomalies may not be discovered until adulthood. • Knowledge of pathology alerts and guides the clinician towards appropriate management.

Hypothalamic lipoma associated with severe obesity. Report of 2 cases

The association between hypothalamic dysfunction and obesity is well documented in both clinical and experimental models. The authors describe 2 children who developed obesity that could not be explained by endocrinological, genetic, or eating disorders. In both cases, cranial MR imaging revealed the typical appearance of a lipoma in the paramedian hypothalamus. In the absence of other etiologies, the authors hypothesized that in these 2 children obesity was caused by their hypothalamic lipomas. To the authors' knowledge, these are the first cases of hypothalamic lipomas likely to be causing obesity that have been described in children. These cases highlight the importance of performing cranial MR imaging in children with otherwise unexplained obesity.

Hypothermia in a child with Hodgkin disease

Hypothermia is an extremely rare clinical manifestation of unknown origin in Hodgkin disease, which is generally associated with the administration of chemotherapeutic agents. We present hypothermia in a 10-year-old girl with stage IIIB nodular sclerosing type Hodgkin disease, who was previously treated with the diagnosis of immune thrombocytopenic purpura. To the best of our knowledge, this case is the first reported case of hypothermia in Hodgkin disease with combination of previously treated immune thrombocytopenic purpura at childhood in the English medical literature.

Parasellar tumors: suprasellar and cavernous sinuses

This article will review the presentation and imaging appearance of tumors affecting the area around the pituitary gland. For convenience, the lesions will be discussed in order of the regions they usually affect. For example, lesions affecting the suprasellar region include craniopharyngiomas, optic or hypothalamic gliomas, germ cell tumors, epidermoids, dermoids, hamartomas, lipomas, and choristomas. Tumors that commonly affect the parasellar cavernous sinus include schwannomas and meningiomas. Tumors like chordomas may arise in the sphenoid bone or clivus and affect the sella. Metastasis, meningiomas and aneurysms may involve any area around the sella. For a detailed discussion of normal anatomy and imaging protocols, see the first article of this monograph.

Hypothermia and Hodgkin's disease: case report and review of the literature

We reported the case of a patient with stage IV Hodgkin's disease (involving the nodes and Liver) presenting with paraneoplastic fever and who subsequently developed hypothermia during chemotherapy administration. We also reviewed the 12 other cases of hypothermia in Hodgkin's disease reported in the literature and discussed the most probable physiopathologic aetiologies.