Growth, puberty and hypothalamic-pituitary function in children with suprasellar arachnoid cyst

A suprasellar arachnoid cyst may cause disorders of growth, puberty and hyp othalamic-pituitary function, due to the proximity of the cyst to the hypot halamic-pituitary area. A total of 30 patients (17 boys) with cyst diagnose d at 4.3 +/- 1 years were routinely evaluated at 5.4 +/- 1 years; 24 of the m had one or multiple cyst derivations. Some 23 cases had an abnormal heigh t, weight or puberty: short ( < -2S D, 5 cases) or tall ( > 2SD, 10 cases) stature, overweight (body mass index, BMI, > 2SD, 6 cases), central precoci ous puberty (10 cases) and/or no progression of pubertal development (3 cas es). The growth hormone (GH) peaks after pharmacological stimulation test w ere low (<10 mu g/l) in 16 patients, confirmed by a second evaluation in 8/ 11 of them. The plasma free thyroxine was low in five patients, prolactin w as high in two and the cortisol and concomitant plasma and urinary osmolali ties were normal. BMI was correlated negatively with the GH peaks (r = -0.3 7, P < 0.01) and positively with the plasma leptin concentrations (r = 0.55 , P < 0.01). The plasma fasting insulin concentrations were also correlated negatively with the GH peaks (r = -0.55, P < 0.02) and positively with the plasma insulin-like growth factor I concentrations (r = 0.64, P < 0.002). The adult height (12 cases) was at 4SD in 1 and < -2SD in 4 patients, two o f whom had precocious puberty untreated with gonadotropin releasing hormone (GnRH) analogue, and two had untreated GH deficiency. The adult height of those treated was normal. One girl had primary amenorrhoea and two boys had low plasma testosterone, despite a normal gonadotropin response to a GnRH test. Conclusion Suprasellar arachnoid cysts may cause deficiencies of growth hor mone and thyrotropin, stimulation of the hypothalamic-pituitary-gonadal axi s, tall stature and/or overweight. These last two disorders may be due to h yperinsulinism, itself due to suprasellar arachnoid cyst.