Case Report: Lipoma of the Tuber Cinereum Mimicking a Pituitary Gland Abnormality in a Girl With Central Precocious Puberty

Abstract

IntroductionMagnetic Resonance Imaging (MRI) is the best approach to investigate the hypothalamic-pituitary region in children with central precocious puberty (CPP). Routine scanning is controversial in girls aged 6-8 year, due to the overwhelming prevalence of idiopathic forms and unrelated incidentalomas. Cerebral lipomas are rare and accidental findings, not usually expected in CPP. We report a girl with CPP and an unusually shaped posterior pituitary gland on SE-T1w sequences.Case DescriptionA 7.3-year-old female was referred for breast development started at age 7. Her past medical history and physical examination were unremarkable, apart from the Tanner stage 2 breast. X-ray of the left-hand revealed a bone age 2-years ahead of her chronological age, projecting her adult height prognosis below the mid parental height. LHRH test and pelvic ultrasound were suggestive for CPP. Routine brain MRI sequences, SE T1w and TSE T2w, showed the posterior pituitary bright spot increased in size and stretched upward. The finding was considered as an anatomical variant, in an otherwise normal brain imaging. Patient was started on treatment with GnRH analogue. At a thorough revaluation, imaging overlap with adipose tissue was suspected and a new MRI scan with 3D-fat-suppression T1w-VIBE sequences demonstrated a lipoma of the tuber cinereum, bordering a perfectly normal neurohypophysis. 3D-T2w-SPACE sequences, acquired at first MRI scan, would have provided a more correct interpretation if rightly considered.ConclusionThis is the first evidence, to our knowledge, of a cerebral lipoma mimicking pituitary gland abnormalities. Our experience highlights the importance of considering suprasellar lipomas in the MRI investigation of children with CPP, despite their rarity, should the T1w sequences show an unexpected pituitary shape. 3D-T2w SPACE sequences could be integrated into standard ones, especially when performing MRI routinely, to avoid potential misinterpretations.

Morphology of the Dorsomedial and Ventral Hypothalamic Nuclei

“…Наприклад, є праці щодо порушення ліпідного обміну при підвищенні температури тіла, власне пов'язані зі змінами центру ліпідного обміну в сірому горбі гіпоталамуса [8]. Також відомі дані про розвиток вторинної аменореї [9], порушень, що імітують захворювання гіпофіза [10] у жінок з утворами сірого горба. Вказане вище свідчить, що багато наукових публікацій присвячено функції гіпоталамуса загалом, а макро-та мікроструктуру сірого горба висвітлено недостатньо.…”

“…For example, there are studies on lipid metabolism disorders with fever, which are actually associated with changes in the lipid metabolism centre in the tuber cinereum of the hypothalamus [8]. There is also evidence of secondary amenorrhoea [9] and disorders mimicking pituitary disease [10] in women with tuber cinereum formations. The above indicates that many scientific publications are devoted to the function of the hypothalamus in general, while the macro-and microstructure of the tuber cinereum are not sufficiently covered.…”

A giant colonic lipoma

“…They are the most common benign soft tissue tumour in adults 1 . Most commonly found subcutaneously on the trunk and limbs, they can also be located in the gastrointestinal tract and rarer locations such as intracerebrally and in the genitourinary tract 2,3 …”

“…1 Most commonly found subcutaneously on the trunk and limbs, they can also be located in the gastrointestinal tract and rarer locations such as intracerebrally and in the genitourinary tract. 2,3 Colonic lipomas are often small, asymptomatic and incidentally found on routine colonoscopy. If small and asymptomatic, they can be left in situ.…”

A case report and literature review of rectal lipoma

“…Lipoma is a benign soft tissue tumor composed of mature adipocytes. [ 1 ] It is common on the surface of the body and can also be seen inside the body. Most lipomas have a soft texture, good mobility, and are generally painless.…”