Attention deficit hyperactivity disorder: diagnosis and treatment masking the ophthalmic clinical presentation of a pineal gland tumour in a teenager
Abstract
A 17-year-old male was found to have a fourth cranial nerve palsy and chronic papilloedema following his presentation to our institution with a 6-week history of blurred vision in both eyes and vertical binocular diplopia. A diagnosis of pineal germinoma was made following imaging studies and endoscopic neurosurgical biopsy of the tumour. He was diagnosed with Attention Deficit Hyperactivity Disorder (ADHD) 3 years earlier and treated with amphetamines. Since this diagnosis, he continued to suffer from hyperactive behaviour, poor concentration, worsening headaches and insomnia. Pineal pathology has a known association with sleep disturbance through the disturbance of melatonin synthesis and/or metabolism. This case report serves to highlight how the presence of organic brain disease presenting to an eye department can be masked by a diagnosis of ADHD.
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In an adolescent with a pineal tumour, sleep/wake alterations had been masked clinically by the presence of an ADHD diagnosis.
“Further, in a case report Cunniffe et al. (2010) report that sleep/wake alterations in an adolescent with a pineal tumour had been masked clinically by the presence of an ADHD diagnosis, thus highlighting the overlap of sleep/wake symptoms resulting from ADHD or pineal dysfunction.”
From A systematic review of circadian function, chronotype and chronotherapy in attention deficit hyperactivity disorder (2017) · cites this paper as Cunniffe et al. (2010)
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- Authors
- Cunniffe, G., Murthy, R., & Beigi, B.
- Affiliations
- Norfolk and Norwich University Hospital (GB)
- Corresponding author
- Cunniffe, G.
- ORCID
- Murthy, R.
- Venue
- International Ophthalmology
- Published
- 2010-03-12
- Volume
- 30
- Issue
- 6
- Pages
- 727-730
- ISSN
- 0165-5701 (ISSN-L)
- 1573-2630
- OpenAlex
- W1969559227
- Cited by
- 2
- References
- 25
- Citations by year
- 2017: 1 · 2016: 1
- FWCI
- 0.00
- Type
- journal article
- Language
- en
- Open access
- closed
- Licence
- www.springer.com/tdm (tdm)
- Locations
- International Ophthalmology (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Pituitary Gland Disorders and Treatments
- Health Sciences › Medicine › Psychiatry and Mental health › Attention Deficit Hyperactivity Disorder
- Life Sciences › Neuroscience › Endocrine and Autonomic Systems › Circadian rhythm and melatonin
- Keywords
- attention deficit hyperactivity disorder, pineal germinoma, ADHD misdiagnosis, fourth nerve palsy, papilledema, diplopia, blurred vision, sleep disorders, melatonin, neuro-ophthalmology
- MeSH terms
- Adolescent, Amphetamines, Attention Deficit Disorder with Hyperactivity, Brain Neoplasms, Diagnosis, Differential, Fundus Oculi, Humans, Male, Papilledema, Pineal Gland, Pinealoma, Tomography, X-Ray Computed, Germinoma
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