Diencephalic syndrome: a frequently neglected cause of failure to thrive in infants.
OBJECTIVE
Diencephalic syndrome is an uncommon cause of failure to thrive in early childhood that is associated with central nervous system neoplasms in the hypothalamic-optic chiasmatic region. It is characterized by complex signs and symptoms related to hypothalamic dysfunction; such nonspecific clinical features may delay diagnosis of the brain tumor. In this study, we analyzed a series of cases in order to define characteristic features of diencephalic syndrome.


METHODS
We performed a retrospective study of 8 patients with diencephalic syndrome (age, 5-38 months). All cases had presented to Seoul National University Children's Hospital between 1995 and 2013, with the chief complaint of poor weight gain.


RESULTS
Diencephalic syndrome with central nervous system (CNS) neoplasm was identified in 8 patients. The mean age at which symptoms were noted was 18±10.5 months, and diagnosis after symptom onset was made at the mean age of 11±9.7 months. The mean z score was -3.15±1.14 for weight, -0.12±1.05 for height, 1.01±1.58 for head circumference, and -1.76±1.97 for weight-for-height. Clinical features included failure to thrive (n=8), hydrocephalus (n=5), recurrent vomiting (n=5), strabismus (n=2), developmental delay (n=2), hyperactivity (n=1), nystagmus (n=1), and diarrhea (n=1). On follow-up evaluation, 3 patients showed improvement and remained in stable remission, 2 patients were still receiving chemotherapy, and 3 patients were discharged for palliative care.


CONCLUSIONS
Diencephalic syndrome is a rare cause of failure to thrive, and diagnosis is frequently delayed. Thus, it is important to consider the possibility of a CNS neoplasm as a cause of failure to thrive and to ensure early diagnosis.
Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea.
Ahlee
A
Kim
Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea.
Jin Soo
JS
Moon
Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea. ; Department of Pediatrics, Seoul National University Bundang Hospital, Seongnam, Korea.
Hye Ran
HR
Yang
Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea. ; Department of Pediatrics, Seoul National University Boramae Medical center, Seoul, Korea.
Ju Young
JY
Chang
Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea.
Jae Sung
JS
Ko
Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea.
Jeong Kee
JK
Seo
Astrocytoma; Brain neoplasms; Failure to thrive; Optic nerve glioma; Pituitary diencephalic syndrome