Failure to thrive as clue to diencephalic tumours in infants

Case reports: Case 1: Failure to thrive up from an age of 5 months with deceleration from the 50th to below the 3rd weight percentile. Exclusion of maldigestive/malabsorptive syndromes. A dietary assessment revealed sub caloric nutrition (47 kcal/kg/d) and an infantile eating disorder was suspected. Following initiation of nasogastic tube feeding, normal weight gain was transitorily achieved. At an age of 10 months a hypothalamic tumour was diagnosed by cerebral ultrasound. (Histology: pilocytic astrocytome WHO I).

Case 2 : Failure to thrive up from an age of 2 months with a drop of weight from the 97th to the 3rd percentile. At an age of 3 months a large hypothalamic tumor with progression towards the optic chiasma was diagnosed by cerebral ultrasound. (Histology: pilocytic astrocytoma WHO I).

Results: We present 2 infants with normal psychomotor development and neurological status in whom diencephalic tumours led to failure to thrive in the absence of signs of elevated intracranial pressure.

Conclusion: In infants presenting with failure to thrive a cerebral tumour should be considered even in the absence of further signs and symptoms. Cerebral ultrasound can lead to early diagnosis.

Keywords: dystrophy, failure to thrive, CNS tumour pilocytic astrocytoma