Craniopharyngioma

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Performed in all patients with craniopharyngioma with suprasellar extension and chiasmal compression.

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Most sensitive and specific imaging modality. [Figure caption and citation for the preceding image starts]: Craniopharyngioma: coronal post-contrast MRIFrom the collection of Marc C. Chamberlain [Citation ends].[Figure caption and citation for the preceding image starts]: Craniopharyngioma: axial post-contrast MRIFrom the collection of Marc C. Chamberlain; used with permission [Citation ends].[Figure caption and citation for the preceding image starts]: Craniopharyngioma: sagittal post-contrast MRIFrom the collection of Marc C. Chamberlain; used with permission [Citation ends].[Figure caption and citation for the preceding image starts]: Craniopharyngioma: sagittal post-contrast MRIFrom the collection of Marc C. Chamberlain [Citation ends].

Allows the clinician to define the size, location, and relationship of the tumour to surrounding structures; to determine the surgical approach; to assess the extent of resection; and to plan radiotherapy.

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Can be helpful in reaching differential diagnosis given the classic calcifications that can be found in craniopharyngiomas. Also used in evaluating relevant sinus anatomy and relationships.

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Increased secretion is due to tumour compression of the pituitary stalk. Measurement of a fasting sample is desirable.

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Values of insulin-like growth factor 1 and its binding protein (IGFBP3) more than two standard deviation scores below the mean, corrected for age and sex, are indicative of growth hormone deficiency; however, normal concentrations do not rule out growth hormone deficiency (e.g., in post-irradiation patients).

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GH deficiency is best evaluated with dynamic testing including either an insulin tolerance test (ITT), glucagon stimulation test, or a growth hormone-releasing hormone/arginine stimulation test, or macimorelin test. ITT is considered the most specific and sensitive test for evaluation of the hypothalamic-pituitary-growth hormone axis. However, it needs to be performed by experienced clinicians and is usually not needed for everyday clinical practice.

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Used to diagnose gonadotrophin hormone deficiency.

Note that in women a normal menstrual cycle is a more sensitive indicator of an intact pituitary and normal gonadal function than any biochemical test.

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Used to diagnose gonadotrophin hormone deficiency.

Note that in women, a normal menstrual cycle is a more sensitive indicator of an intact pituitary and normal gonadal function than any biochemical test.

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Used to diagnose gonadotrophin hormone deficiency in men.

Check fasting levels between 6 a.m. and 8 a.m. ideally; sample taken up to 11 a.m. is acceptable.

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There may be low bioactivity of TSH (normal TSH levels but reduced activity in stimulating thyroid hormone release). Therefore, TSH alone should not be used to diagnose thyroid hormone deficiency.

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Used to diagnose adrenal insufficiency.

Blood should be drawn between 8 a.m. and 9 a.m., when cortisol levels peak.

It is important to realise that arginine vasopressin deficiency (AVP-D; previously known as central diabetes insipidus) cannot occur in the presence of chronic low mineralocorticoids; administration of corticosteroids can unmask low vasopressin and result in the onset of severe AVP-D.

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Used to diagnose arginine vasopressin deficiency (AVP-D; previously known as central diabetes insipidus). Elevated serum sodium in association with hypotonic urine (urine osmolality <300 mmol/kg [<300 mOsm/kg]) strongly suggests AVP-D.

Low sodium may be seen with adrenocorticotrophic hormone or thyroid-stimulating hormone deficiency.

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Used to diagnose arginine vasopressin deficiency (AVP-D; previously known as central diabetes insipidus).

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Used to diagnose growth hormone deficiency.

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A stimulation test may be considered in a patient with an indeterminate serum cortisol value to determine adrenal insufficiency.

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Allows for definitive diagnosis following surgical biopsy/resection with pathological analysis of tumour tissue. [Figure caption and citation for the preceding image starts]: Craniopharyngioma: adamantinous histology (low power) with complex arrangements of epithelium, cysts, and gliotic brainFrom the collection of Marc C. Chamberlain [Citation ends].[Figure caption and citation for the preceding image starts]: Craniopharyngioma: adamantinous histology (medium power) with epithelial ribbons showing reticular areas and nodules of keratinFrom the collection of Marc C. Chamberlain [Citation ends].[Figure caption and citation for the preceding image starts]: Craniopharyngioma: adamantinous histology (high power) with basal-aligned columnar cells, stellate reticulum, and epithelial keratinisationFrom the collection of Marc C. Chamberlain [Citation ends].