Abstract | OBJECTIVE: To report a case of superior mesenteric artery (SMA) syndrome secondary to hypothalamic germinoma. METHODS: We describe the clinical presentation, diagnostic work-up, management, and clinical course of a patient admitted with SMA syndrome who was subsequently found to have a hypothalamic germinoma. RESULTS: An adolescent boy was admitted to the surgical ward with progressive weight loss over a 2 year period and postprandial vomiting. He was diagnosed with SMA syndrome based on evidence of proximal duodenal dilatation, extrinsic compression of the distal duodenum, and a narrowed aortomesenteric angle (16°). Investigations performed to exclude thyrotoxicosis unexpectedly revealed secondary hypothyroidism and further evaluation demonstrated evidence of pan- hypopituitarism. Psychiatric evaluation excluded anorexia nervosa and bulimia. Magnetic resonance imaging (MRI) of the brain revealed a heterogeneously enhancing hypothalamic lesion, but a normal pituitary gland. Hormone replacement with hydrocortisone, desmopressin, testosterone, and thyroxine resulted in weight gain and resolution of gastrointestinal symptoms. A transventricular endoscopic biopsy subsequently confirmed a hypothalamic germinoma and he was referred to an oncologist. CONCLUSION:
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Authors | Shireene R Vethakkan, Yogeswari Venugopal, Alexander T B Tan, Sharmila S Paramasivam, Jeyakantha Ratnasingam, Rohaya A Razak, Azmi Alias, Fauziah Kassim, Karen Choong |
Journal | Endocrine practice : official journal of the American College of Endocrinology and the American Association of Clinical Endocrinologists
(Endocr Pract)
2013 Jan-Feb
Vol. 19
Issue 1
Pg. e29-34
ISSN: 1934-2403 [Electronic] United States |
PMID | 23186972
(Publication Type: Case Reports, Journal Article)
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Topics |
- Brain Neoplasms
(complications, diagnostic imaging)
- Germinoma
(complications, diagnostic imaging)
- Humans
- Hypothalamus
(diagnostic imaging)
- Male
- Radiography
- Superior Mesenteric Artery Syndrome
(diagnostic imaging, etiology)
- Young Adult
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