Expectant management of a hypothalamic mass: a case report.

Background: Although hypothalamic masses are usually benign, they may infiltrate hypothalamic-pituitary structures, resulting in multiple endocrinopathies, optic nerve damage, increased intracranial pressure, and death. Controversy exists regarding proper management.

Case: A young woman with a hypothalamic mass suggestive of craniopharyngioma presented with pubertal delay and hypothalamic amenorrhea without evidence of progression over 4 years. She was given sex steroid replacement and observed, thereby avoiding surgery or radiotherapy.

Conclusion: Large hypothalamic masses may present with minimal signs and symptoms that are not life threatening. Without more serious symptoms, these can be managed expectantly to avoid the risks of panhypopituitarism, diabetes insipidus, vision loss, and cerebrovascular accidents resulting from any therapy.