Skip to main content

Advertisement

SpringerLink
Log in

Attention deficit hyperactivity disorder: diagnosis and treatment masking the ophthalmic clinical presentation of a pineal gland tumour in a teenager

  • Case Report
  • Published:
International Ophthalmology Aims and scope Submit manuscript

Abstract

A 17-year-old male was found to have a fourth cranial nerve palsy and chronic papilloedema following his presentation to our institution with a 6-week history of blurred vision in both eyes and vertical binocular diplopia. A diagnosis of pineal germinoma was made following imaging studies and endoscopic neurosurgical biopsy of the tumour. He was diagnosed with Attention Deficit Hyperactivity Disorder (ADHD) 3 years earlier and treated with amphetamines. Since this diagnosis, he continued to suffer from hyperactive behaviour, poor concentration, worsening headaches and insomnia. Pineal pathology has a known association with sleep disturbance through the disturbance of melatonin synthesis and/or metabolism. This case report serves to highlight how the presence of organic brain disease presenting to an eye department can be masked by a diagnosis of ADHD.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

References

  1. Carrol N, Neal LA (1997) Diencephalic tumours presenting as behavioural problems in the workplace. Occup Med (Lond) 47(1):52–54

    Article  Google Scholar 

  2. Edgeworth J, Bullock P, Bailey A et al (1996) Why are brain tumours still being missed? Arch Dis Child 74(2):148–151

    Article  CAS  PubMed  Google Scholar 

  3. Rudolph AM, Hoffman JE (1987) Paediatrics, 18th edn. Appleton & Lange, East Norwalk, CT

    Google Scholar 

  4. Jennings MT, Gelman R, Hochberg F (1985) Intracranial germ-cell tumours: natural history and pathogenesis. J Neurosurg 63:155–167

    Article  CAS  PubMed  Google Scholar 

  5. Buchfelder M, Fahlbusch M, Walther M, Mann K (1989) Endocrine disturbances in the suprasellar germinomas. Acta Endocrinol (Copenh) 120:337–342

    CAS  Google Scholar 

  6. Shinoda J, Miwa Y, Sakai N et al (1985) Immunohistochemical study of placental alkaline phosphatase in primary intracranial germ-cell tumours. J Neurosurg 63:733–739

    Article  CAS  PubMed  Google Scholar 

  7. American Psychiatric Association (1994) Diagnostic and statistical manual of mental disorders, 4th edn. American Psychiatric Association, Washington, DC

    Google Scholar 

  8. Horowitz MB, Hall WA (1991) Central nervous system germinomas. Arch Neurol 48:652–657

    CAS  PubMed  Google Scholar 

  9. Bailey S, Skinner R, Lucraft HH et al (1996) Pineal tumours in the north of England 1968–93. Arch Dis Child 75:181–185

    Article  CAS  PubMed  Google Scholar 

  10. Baumgartner JE, Edwards MS (1992) Pineal tumors. Neurosurg Clin N Am 3(4):853–862

    CAS  PubMed  Google Scholar 

  11. Hoffman HJ, Yoshida M, Becker LE et al (1983) Experience with pineal region tumours in childhood. Experiences at the Hospital for Sick Children. In: Humphrey RP (ed) Concepts in paediatric neurosurgery. Karger, Basel, pp 360

  12. Bloom HJ (1983) Primary intracranial germ-cell tumours. Clin Oncol 2:233–257

    Google Scholar 

  13. Edwards MSB, Hudgins RJ, Wilson CB (1988) Pineal region tumours in children. J Neurosurg 68:689–697

    Article  CAS  PubMed  Google Scholar 

  14. Wara WM, Jenkin RDT, Evans A et al (1997) Tumours of the pineal and suprasellar region, Childrens Cancer Study Group treatment results, 1960–1975. Cancer 43:698–701

    Article  Google Scholar 

  15. Smith DB, Newlands ES, Begent RH et al (1991) Optimum management of pineal germ cell tumours. Clin Oncol (R Coll Radiol) 3:96–99

    CAS  Google Scholar 

  16. Dearnaley DP, A’Hern RP, Whittaker S, Bloom HJG (1990) Pineal and CNS germ cell tumours: Royal Marsden Hospital experience 1962–1987. Int J Radiat Oncol Biol Phys 18:773–781

    Article  CAS  PubMed  Google Scholar 

  17. Lindstadt D, Wara WM, Edwards MS et al (1988) Radiotherapy of primary intracranial germinomas: the case against routine craniospinal irradiation. J Radiat Oncol Biol Phys 15:291–297

    Article  Google Scholar 

  18. Fields JN, Fulling KH, Thomas PR, Marks JE (1987) Suprasellar germinoma: radiation therapy. Radiology 164:247–249

    CAS  PubMed  Google Scholar 

  19. Shibamoto Y, Abe M, Yamashita J et al (1988) Treatment results of intracranial germinoma as a function of irradiated volume. Int J Radiol Oncol Biol Phys 15:285–290

    Article  CAS  Google Scholar 

  20. Hudgins RJ, Hudgins PA (1990) Pineal region tumours in children. Contemp Neurosurg 12:1–6

    Google Scholar 

  21. Etzioni A, Luboshitzky R, Tiosano D et al (1996) Melatonin replacement corrects sleep disturbances in a child with pineal tumour. Neurology 46:261–263

    CAS  PubMed  Google Scholar 

  22. Barkley RA, Fischer M, Fletcher K et al (2002) Persistence of attention deficit hyperactivity disorder into adulthood as a function of reporting source and definition of the disorder. J Abnorm Psychol 11:279–289

    Article  Google Scholar 

  23. Brown FR, Voigt RG, Elksnin N (1996) ADHD: a neurodevelopmental perspective. Contemp Paediatr 13:25–44

    Google Scholar 

  24. Ahmann PA, Waltonen SJ, Olsen KA et al (1993) Placebo-controlled evaluation of Ritalin side effects. Paediatrics 91(6):1101–1106

    CAS  Google Scholar 

  25. Barkley R, McMurray MB, Edelbrock CS, Robbins K (1990) Side effects of methylphenidate in children with attention deficit hyperactivity disorder: a systemic, placebo-controlled evaluation. Paediatrics 86(2):184–192

    CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Norfolk and Norwich University Hospital NHS Trust, Colney Lane, Norwich, NR4 7UY, England, UK

    G. Cunniffe, R. Murthy & B. Beigi

Authors
  1. G. Cunniffe
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. R. Murthy
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. B. Beigi
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to G. Cunniffe.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Cunniffe, G., Murthy, R. & Beigi, B. Attention deficit hyperactivity disorder: diagnosis and treatment masking the ophthalmic clinical presentation of a pineal gland tumour in a teenager. Int Ophthalmol 30, 727–730 (2010). https://doi.org/10.1007/s10792-010-9356-1

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10792-010-9356-1

Keywords

Search

Navigation