Giant craniopharyngioma presenting with new onset seizure
The present case has been reported in the journal BMJ. A 43-year-old man presented to the emergency department after experiencing a first episode seizure. No further information was available at presentation as the patient was confused on his arrival.

On physical examination, vital signs were normal. The patient was confused, and his Glasgow Coma Score was 12(E3V4M5). Initial workup included complete blood count, electrolytes and ECG were normal. Thyroid function tests, insulin growth factor-1 and plasma random cortisol level were within the normal range. Testosterone levels were low, and luteinising hormone was inappropriately normal.

CT demonstrated a cystic mass with peripheral calcification measuring 6.0×4.5×3.9 cm. The lesion originated from the pituitary fossa and expanded superiorly distorting the third ventricle and the left lateral ventricle causing hydrocephalus. A pituitary MRI confirmed these findings. The patient underwent a craniotomy with mass resection.

The procedure was uneventful. Pathology demonstrated nodular whorls and irregular trabeculae of well-differentiated squamous epithelium, bordered by palisading columnar cell consistent with an adamantinomatous craniopharyngioma (CP) (WHO grade I).

Postoperatively, the patient developed panhypopituitarism, and on close monitoring, he was noted to have hypothalamic dysfunction manifesting with hypothermia, hypoglycaemia and adipsia.

Learning points
• Craniopharyngiomas are usually benign and their morbidity usually results from damage of surrounding structures due to compression.

• In adults, the average tumour size is 3 cm, and giant craniopharyngiomas are rare.

• Larger tumours are more likely to compress surrounding structures and associated with worse outcomes.

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