History and exam

Key diagnostic factors

common

visual loss

Due to optic tract or chiasm compression or tumour infiltration.[5][7][25]​ Children are more likely to present with acute loss of vision; in other age groups visual loss, although common, may be insidious in onset.

macrocephaly and hydrocephalus

Macrocephaly may be seen in infants before intracranial sutures fuse, and suggests hydrocephalus, secondary to ventricular outflow obstruction by an intracranial mass.[4][5]

faltering growth

Craniopharyngioma is the most common cause of faltering growth due to an intracranial tumour.[5][9][21]

In children with craniopharyngioma, growth hormone deficiency (causing faltering growth) commonly precedes diagnosis.[27] Faltering growth is rarely a cause for referral prior to diagnosis of craniopharyngioma.[9][28]

Other diagnostic factors

common

symptoms of hypogonadotrophic hypogonadism (amenorrhoea, erectile dysfunction)

Craniopharyngioma may present with common symptoms of endocrine dysfunction in older patients.[5][9][10][11][21]

Symptoms of hypogonadism in women include primary or secondary amenorrhoea and, in men, erectile dysfunction due to low testosterone secondary to compression of the adenohypophysis or to elevated prolactin.

headache

Brain tumours often cause headaches that are progressive, often associated with other neurological symptoms, and may be worse in the morning.[3][4][5]

symptoms of intracranial hypertension (nausea, vomiting, decreased sensorium, diplopia)

Raised intracranial pressure is seen with large craniopharyngiomas. Develops as a consequence of tumour obstructing the ventricles, resulting in hydrocephalus.[3][4][5]

galactorrhoea

Result of hyperprolactinaemia secondary to compression of the adenohypophysis, pituitary stalk, or hypothalamus.[5][9][10][21]

uncommon

optic atrophy

Due to chronic optic nerve compression by tumour or chronic intracranial hypertension.[3][4][5]

polyuria/polydipsia

Result of arginine vasopressin deficiency (previously known as central diabetes insipidus) with decreased vasopressin release secondary to pituitary stalk or hypothalamic compression by tumour.[5][9][10][21]

Risk factors

weak

age 5 to 14 years

Although craniopharyngioma may present at any age, a bimodal age distribution is reported with a peak between 5 and 14 years of age and between 50 and 70 years of age.[13][15][16][17]

age 50 to 70 years

Although craniopharyngioma may present at any age, a bimodal age distribution is reported with a peak between 5 and 14 years of age and between 50 and 70 years of age.[13][15][16][17]

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