Differential Diagnosis
The patient's symptoms, including continuous headache, nausea, visual difficulty, and frequent urination, along with the findings of bitemporal hemianopia and a calcified mass in the suprasellar area, guide the differential diagnosis.
Single most likely diagnosis
- A) Craniopharyngioma: This is the most likely diagnosis due to the presence of a calcified mass in the suprasellar area, which is a characteristic feature of craniopharyngiomas. These tumors often present with visual disturbances, endocrine dysfunction (which could explain the short stature and obesity), and increased intracranial pressure (leading to headache and nausea).
Other Likely diagnoses
- E) Pituitary tumor: Although less likely than craniopharyngioma due to the absence of specific endocrine abnormalities mentioned and the presence of calcification, pituitary tumors can cause similar symptoms by compressing surrounding structures. However, calcification is less common in pituitary tumors.
- D) Optic nerve glioma: These tumors can cause visual disturbances but are less likely to present with a calcified mass in the suprasellar area. They are more commonly associated with neurofibromatosis type 1.
Do Not Miss diagnoses
- C) Meningioma: Although meningiomas are rare in adolescents, they can present with similar symptoms due to compression of adjacent structures. Meningiomas can calcify, but their occurrence in this age group and location makes them less likely.
- B) Ependymoma: Ependymomas are less common in the suprasellar region and more typically occur in the ventricular system. However, they can present with increased intracranial pressure and visual disturbances if they obstruct CSF pathways or compress nearby structures.
Rare diagnoses
- Germinoma: These tumors can occur in the suprasellar region and present with endocrine dysfunction, visual disturbances, and diabetes insipidus (which could explain frequent urination). However, they are less likely to be calcified and are not as commonly considered initially without specific endocrine abnormalities or a more characteristic presentation.
- Other rare tumors: Such as choroid plexus papillomas, pineal region tumors, or metastatic disease, could also present with similar symptoms but are less likely given the specific location and characteristics of the mass described.