title: ADHD-like behavior in a patient with hypothalamic hamartoma.
abstract: We report a male patient with hypothalamic hamartoma (HH) who manifested central precocious puberty (CPP) at 4 years of age. Gonadotropin-releasing hormone (GnRH) analogue treatment was started at 6 years of age and his pubertal signs were suppressed. At 9 years of age, the patient was emotionally unstable, aggressive, and antisocial. He had severe attention deficit hyperactivity disorder (ADHD)-like behavior and conduct disorder. No seizure activity was observed. GnRH analogue treatment was discontinued for 8 months from 9 years and 4 months of age due to his mother's illness. During this period sexual urges were observed. Treatment with daily methylphenidate markedly improved his behavioral problems. However, his sexual urges were not suppressed until 3 months after the GnRH analogue treatment was restarted. The present case is unique because the patient's behavioral problems were observed despite the parahypothalamic type of HH and absence of seizures. This case is also rare because behavioral problems were observed without seizures, and no ADHD cases with hamartoma have been reported previously. Recently, clinical studies have described an association between psychiatric morbidity, including ADHD, and hyperandrogenism disorders. Our patient's ADHD-like symptoms might be due to hyperandrogenism. In such cases, GnRH analogue with methylphenidate could be effective for improving ADHD-like symptoms.
authors.affiliation: Department of Pediatrics and Child Health, Kurume University School of Medicine, Japan.
authors.forename: Koujyu
authors.initials: K
authors.lastname: Katayama
authors.affiliation: Department of Pediatrics and Child Health, Kurume University School of Medicine, Japan. Electronic address: yushiro@med.kurume-u.ac.jp.
authors.forename: Yushiro
authors.initials: Y
authors.lastname: Yamashita
authors.affiliation: Department of Pediatrics and Child Health, Kurume University School of Medicine, Japan.
authors.forename: Shuichi
authors.initials: S
authors.lastname: Yatsuga
authors.affiliation: Department of Pediatrics and Child Health, Kurume University School of Medicine, Japan.
authors.forename: Yasutoshi
authors.initials: Y
authors.lastname: Koga
authors.affiliation: Department of Pediatrics and Child Health, Kurume University School of Medicine, Japan.
authors.forename: Toyojiro
authors.initials: T
authors.lastname: Matsuishi
mesh_terms: D001289:Attention Deficit Disorder with Hyperactivity / Q000523:psychology; D001921:Brain / Q000473:pathology; D000697:Central Nervous System Stimulants / Q000627:therapeutic use; D002648:Child; D006222:Hamartoma / Q000188:drug therapy / Q000473:pathology / Q000503:physiopathology / Q000523:psychology*; D006801:Humans; D007027:Hypothalamic Diseases / Q000188:drug therapy / Q000473:pathology / Q000503:physiopathology / Q000523:psychology*; D008297:Male; D008774:Methylphenidate / Q000627:therapeutic use; D012725:Sexual Behavior / Q000187:drug effects
chemical_list: D000697:Central Nervous System Stimulants; D008774:Methylphenidate
keywords: Attention deficit hyperactivity disorder; Central precocious puberty; Conduct disorder; Gonadotropin-releasing hormone analogue; Hypothalamic hamartoma