Puberdade precoce causada por tumores intracranianos: relato de 4 casos

Brandt, Reynaldo A.; Carvalho, Rui R. D.

doi:10.1590/S0004-282X1974000400008

Resumos

São relatados 4 casos de puberdade precoce conseqüentes a tumores intracranianos: um teratoma adulto do ventrículo lateral, um astrocitoma protoplasmático do terceiro ventrículo e diencéfalo, um astroblastoma do ter- ceiro ventrículo e diencéfalo e um hamartoma hipotalâmico. São apresentadas teorias que tentam explicar os mecanismos hormonais envolvidos e é salientada a importância do diagnóstico neuroradiológico preciso, pela possibilidade de cura em alguns casos e de tratamento satisfatório nos demais.

Four cases of precocious puberty secondary to intracranial tumors are reported. A 3 year and 11 month old boy had a teratoma in the left lateral ventricle and total surgical excision was followed by recovery. An 8 year old girl with a protoplasmic astrocytoma of the third ventricle diagnosed by biopsy, followed by shunting and cobalt therapy was discharged improved. A five year old boy with an extensive astroblastoma of the diencephalon died following biopsy and shunting of cerebrospinal fluid. A posterior hypothalamic hamartoma totally excised from a 3 year old girl was followed by remission of the precocious puberty. The theories of hormonal mechanisms leading to precocious puberty are presented. It is stressed the importance of pneumoencephalography in the diagnosis of intracranial hamartomas, for they lack neurological signs.

Puberdade precoce causada por tumores intracranianos. Relato de 4 casos

Pubertas praecox due to intracranial tumors: report of 4 cases

Reynaldo A. Brandt; Rui R. D. Carvalho

Disciplina de Neurocirurgia da Faculdade de Ciências Médicas da Santa Casa de São Paulo

RESUMO

São relatados 4 casos de puberdade precoce conseqüentes a tumores intracranianos: um teratoma adulto do ventrículo lateral, um astrocitoma protoplasmático do terceiro ventrículo e diencéfalo, um astroblastoma do ter- ceiro ventrículo e diencéfalo e um hamartoma hipotalâmico. São apresentadas teorias que tentam explicar os mecanismos hormonais envolvidos e é salientada a importância do diagnóstico neuroradiológico preciso, pela possibilidade de cura em alguns casos e de tratamento satisfatório nos demais.

SUMMARY

Four cases of precocious puberty secondary to intracranial tumors are reported. A 3 year and 11 month old boy had a teratoma in the left lateral ventricle and total surgical excision was followed by recovery. An 8 year old girl with a protoplasmic astrocytoma of the third ventricle diagnosed by biopsy, followed by shunting and cobalt therapy was discharged improved. A five year old boy with an extensive astroblastoma of the diencephalon died following biopsy and shunting of cerebrospinal fluid. A posterior hypothalamic hamartoma totally excised from a 3 year old girl was followed by remission of the precocious puberty. The theories of hormonal mechanisms leading to precocious puberty are presented. It is stressed the importance of pneumoencephalography in the diagnosis of intracranial hamartomas, for they lack neurological signs.

Texto completo disponível apenas em PDF.

Full text available only in PDF format.

Disciplina de Neurocirurgia Faculdade de Ciências Médicas da Santa Casa Rua Cesário Motta Jr. 112 01221 São Paulo SP Brasil.

1. ANDERSON, E. & HAYMAKER, W. Disorders of the hypothalamus and pituitary gland. In Clinical Neurology, Hoeber-Harper, New York, 1962.
2. BRAUN, F. C. JR. & FORNEY, W. R. Diencephalic syndrome of early infancy associated with brain tumor: report of a case and review of the literature. Pediatrics 24:609, 1959.
3. COSTIN, G.; FEFERMAN, R. A. & KOGUT, M. D. Hypothalamic gigantism. J. Pediat. 83:419, 1973.
4. DODS, L. A diencephalic syndrome of early infancy. Med. J. Aust. 2:689, 1957.
5. FARIS, A. A.; BALE, G. F.; CANNON, B. Arachnoid cyst of the third ventricle with precocious puberty. South. Med. J. 64:1139, 1971.
6. HARRIS, G. W. & JACOBSOHN, D. Functional grafts of anterior pituitary gland. Proc. Roy. Soc. (London) 139:263, 1952.
7. HUNG, W.; MILHORAT, T. H.; NELSON, K. B. & AUGUST, G. P. Sexual precocity as the only sign of a brain tumor in a 9-year-old boy. Amer. J. Dis. Child. 121:524, 1971.
8. JENKINS, J. S. The hypothalamus. British Med. J. 2:99, 1972.
9. KAGEYAMA, N. Ectopic pinealoma in the region of the optic chiasm. J. Neurosurg. 35:755, 1971.
10. LIST, C. F.; DOWMAN, C. E.; BAGCHI, B. K. & BEBIN, J. Posterior hypothalamic hamartomas and gangliogliomas causing precocious puberty. Neurology (Minneapolis) 8:164, 1958.
11. MC DONOUGH, P. G. Sexual precocity. Clin. Obstet. Gynecol. 14:1037, 1971.
12. NORTHFIELD, D. W. C. & RUSSEL, D. S. Pubertas praecox due to hypothalamic hamartoma: report of two cases surviving surgical removal of the tumor. J. Neurol. Neurosurg. Psychiat. 30:166, 1967.
13. PAGE, R. B.; GALICICH, J. H. & GRUNT, J. A. Alteration of circadian temperature rythm with third ventricular obstruction. J. Neurosurg. 38:309, 1973.
14. POZNANSKI, A. K. & MANSON, G. Radiographic appearance of the soft tissues in the diencephalic syndrome of infancy. Radiology 81:101, 1963.
15. RUBINSTEIN, L. J. Tumors of the Central Nervous System. Armed Forces Institute of Pathology, Washington D.C., 1972.
16. RUSSEL, A. A diencephalic syndrome of hiperkinetic emaciation typically linked to predominant elation in infancy and early childhood. In Van Bogaert, L. Sixth International Congress of Neurology (Brussels, July 1957). Excerpta Medica Sec. VIII, pp. 111.
17. RUSSEL, D. S. The pinealoma: its relationship to teratoma. J. Pat. Bact. 56:145, 1944.
18. RUSSEL, D. D. & RUBINSTEIN, L. J. Pathology of Tumours of the Nervous System. Edward Arnold, London, 1971.
19. SCHMIDT, E.; HALLERWORDEN, J. & SPATZ, H. Die Entstehung der Hamartome am Hypothalamus mit und ohne Pubertas praecox. Dtsch. Z. Nervenheilkd. 177:235, 1958.
20. SCHONBERG, D. Hamartome des Tuber cinereum bei Pubertas praecox. Endokrinologie und Diagnostik in vivo. Radiologe 11:319, 1971.
21. SOTOS, J. F.; DODGEN, P. R.; MUIRHEAD, D.; CRAMFORD, J. D. & TALBOT, N. B. Cerebral gigantism in childhood. A syndrome of excessively rapid growth with acromegalic features and a non-progressive neurologic disorder. New. England J. Med. 271:109, 1964.
22. TORREY, E. F. & UYEDA, C. I. The diencephalic syndrome of infancy. Amer. J. Dis. Child. 110:689, 1965.
23. TROLAND, C. E. & BROWN, C. A. Precocious puberty of intracranial origin. J. Neurosurg. 5:541, 1948.
24. WOLMAN, L. & BALMFORTH, G. V. Precocious puberty due to hypothalamic hamartoma in a patient surviving to late middle age. J. Neurol. Neurosurg. Psychiat. 26:275, 1962.
25. WEISS, S. R. & ROSKIND, R. Conray ventriculography in the diagnosis of brain tumors and congenital malformations in children. J. Neurosurg. 34:408, 1971.

Datas de Publicação

Publicação nesta coleção
09 Abr 2013
Data do Fascículo
Dez 1974

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

[1] 1. ANDERSON, E. & HAYMAKER, W. Disorders of the hypothalamus and pituitary gland. In Clinical Neurology, Hoeber-Harper, New York, 1962.

[2] 2. BRAUN, F. C. JR. & FORNEY, W. R. Diencephalic syndrome of early infancy associated with brain tumor: report of a case and review of the literature. Pediatrics 24:609, 1959.

[3] 3. COSTIN, G.; FEFERMAN, R. A. & KOGUT, M. D. Hypothalamic gigantism. J. Pediat. 83:419, 1973.

[4] 4. DODS, L. A diencephalic syndrome of early infancy. Med. J. Aust. 2:689, 1957.

[5] 5. FARIS, A. A.; BALE, G. F.; CANNON, B. Arachnoid cyst of the third ventricle with precocious puberty. South. Med. J. 64:1139, 1971.

[6] 6. HARRIS, G. W. & JACOBSOHN, D. Functional grafts of anterior pituitary gland. Proc. Roy. Soc. (London) 139:263, 1952.

[7] 7. HUNG, W.; MILHORAT, T. H.; NELSON, K. B. & AUGUST, G. P. Sexual precocity as the only sign of a brain tumor in a 9-year-old boy. Amer. J. Dis. Child. 121:524, 1971.

[8] 8. JENKINS, J. S. The hypothalamus. British Med. J. 2:99, 1972.

[9] 9. KAGEYAMA, N. Ectopic pinealoma in the region of the optic chiasm. J. Neurosurg. 35:755, 1971.

[10] 10. LIST, C. F.; DOWMAN, C. E.; BAGCHI, B. K. & BEBIN, J. Posterior hypothalamic hamartomas and gangliogliomas causing precocious puberty. Neurology (Minneapolis) 8:164, 1958.

[11] 11. MC DONOUGH, P. G. Sexual precocity. Clin. Obstet. Gynecol. 14:1037, 1971.

[12] 12. NORTHFIELD, D. W. C. & RUSSEL, D. S. Pubertas praecox due to hypothalamic hamartoma: report of two cases surviving surgical removal of the tumor. J. Neurol. Neurosurg. Psychiat. 30:166, 1967.

[13] 13. PAGE, R. B.; GALICICH, J. H. & GRUNT, J. A. Alteration of circadian temperature rythm with third ventricular obstruction. J. Neurosurg. 38:309, 1973.

[14] 14. POZNANSKI, A. K. & MANSON, G. Radiographic appearance of the soft tissues in the diencephalic syndrome of infancy. Radiology 81:101, 1963.

[15] 15. RUBINSTEIN, L. J. Tumors of the Central Nervous System. Armed Forces Institute of Pathology, Washington D.C., 1972.

[16] 16. RUSSEL, A. A diencephalic syndrome of hiperkinetic emaciation typically linked to predominant elation in infancy and early childhood. In Van Bogaert, L. Sixth International Congress of Neurology (Brussels, July 1957). Excerpta Medica Sec. VIII, pp. 111.

[17] 17. RUSSEL, D. S. The pinealoma: its relationship to teratoma. J. Pat. Bact. 56:145, 1944.

[18] 18. RUSSEL, D. D. & RUBINSTEIN, L. J. Pathology of Tumours of the Nervous System. Edward Arnold, London, 1971.

[19] 19. SCHMIDT, E.; HALLERWORDEN, J. & SPATZ, H. Die Entstehung der Hamartome am Hypothalamus mit und ohne Pubertas praecox. Dtsch. Z. Nervenheilkd. 177:235, 1958.

[20] 20. SCHONBERG, D. Hamartome des Tuber cinereum bei Pubertas praecox. Endokrinologie und Diagnostik in vivo. Radiologe 11:319, 1971.

[21] 21. SOTOS, J. F.; DODGEN, P. R.; MUIRHEAD, D.; CRAMFORD, J. D. & TALBOT, N. B. Cerebral gigantism in childhood. A syndrome of excessively rapid growth with acromegalic features and a non-progressive neurologic disorder. New. England J. Med. 271:109, 1964.

[22] 22. TORREY, E. F. & UYEDA, C. I. The diencephalic syndrome of infancy. Amer. J. Dis. Child. 110:689, 1965.

[23] 23. TROLAND, C. E. & BROWN, C. A. Precocious puberty of intracranial origin. J. Neurosurg. 5:541, 1948.

[24] 24. WOLMAN, L. & BALMFORTH, G. V. Precocious puberty due to hypothalamic hamartoma in a patient surviving to late middle age. J. Neurol. Neurosurg. Psychiat. 26:275, 1962.

[25] 25. WEISS, S. R. & ROSKIND, R. Conray ventriculography in the diagnosis of brain tumors and congenital malformations in children. J. Neurosurg. 34:408, 1971.