BMJ Case Reports 2012; doi:10.1136/bcr-2012-006870
  • Reminder of important clinical lesson

An unusual suspect causing behavioural problems and pituitary failure in a child

  1. Richard Stocks2
  1. 1Norwich Medical School, University of East Anglia, Norwich, Norfolk, UK
  2. 2Paediatric Department, James Paget University Hospital, Great Yarmouth, Norfolk, UK
  1. Correspondence to Justin Conrad Rosen Wormald, j.wormald{at}


A 9-year-old boy presented with feeding and behavioural problems and was diagnosed with Autistic Spectrum Disorder and Attention Deficit Hyperactivity Disorder. By age 11 he was becoming increasingly disinhibited and was refusing almost all oral food intake. Believing the cause to be psychogenic, he was placed in an inpatient eating disorder facility. After 3 days of continuous vomiting and minimal intake, he was admitted back to hospital for further investigations. A hypovolaemic hypernatraemia prompted an MRI brain scan, revealing several tumour masses with suprasellar and pituitary involvement. Histological investigation revealed primary, non-malignant germ-cell tumours. The tumours were treated with craniopharyngeal radiotherapy and permanent pituitary hormone replacement.

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