Education And Debate

Lesson of the Week: Occult intracranial tumours masquerading as early onset anorexia nervosa

BMJ 1995; 311 doi: https://doi.org/10.1136/bmj.311.7016.1359 (Published 18 November 1995) Cite this as: BMJ 1995;311:1359
  1. C J DeVile, clinical research fellowa,
  2. R Sufraz, registrar in psychiatrya,
  3. B D Lask, consultant psychiatrista,
  4. R Stanhope, consultant paediatric endocrinologista
  1. aMedical Unit and Department of Psychological Medicine, Institute of Child Health and Great Ormond Street Hospital for Children NHS Trust, London WC1N 1EH
  1. Correspondence to: Dr Stanhope.
  • Accepted 21 July 1995

Childhood onset anorexia nervosa may be difficult to diagnose because of the lack of clear diagnostic criteria for prepubertal children and because of the difficulty of differentiating psychogenic from organic disease.1 Psychological disturbance and symptoms of anorexia without neurological manifestation may also be presenting features of an early intracranial lesion, usually affecting the diencephalon--as shown by the following three cases.

Any boy with apparent anorexia should have careful anthropometric and endocrine assessment as well as cranial imaging,which may need to be repeated

Case reports CASE 1

An 8 1/2 year old boy presented with a six month history of intermittent headaches and vomiting. Clinical examination was unremarkable. A provisional diagnosis of migraine was made after unenhanced computed tomography of the brain showed nothing abnormal. Seven months after presentation the initial symptoms had settled but the patient had developed anorexia. Onset of physical symptoms coincided with the patient becoming introverted, emotionally labile, and periodically morose. His mother had died from a hepatocellular carcinoma when he was 3 years. The combination of unresolved grief, his father being admitted to hospital for a routine operation, and his eldest sister leaving home were thought to have precipitated this change in personality. He could not be coaxed into eating and was referred to a child psychiatrist, who diagnosed childhood onset anorexia nervosa with depression. Over the next nine months the patient continued solely under psychiatric follow up but with negligible improvement in weight gain or stature. His home environment was thought to be contributory, and, in view of these concerns, he was placed on the child protection register.

The patient was subsequently admitted to …

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