Craniopharyngioma Simulating Anorexia Nervosa

Tumors in the hypothalamic region may simulate anorexia nervosa, and the differentiation of these conditions can be exceedingly difficult. A clinical history of 4 years' duration is presented which, in retrospect, is quite compatible with the presentation of a craniopharyngioma. There were several factors which made diagnosis and management of this patient difficult. There were features atypical of the radiological picture of craniopharyngioma; the positive diagnosis of anorexia nervosa was not established beyond doubt; and there were features in the personality of the patient which may have elicited countertransference reactions that made objective assessment more difficult. The fact that only 75 per cent of craniopharyngiomas have the characteristic radiological features and the need for a positive diagnosis of anorexia nervosa with particular attention to “the anorectic behavior” are briefly reviewed. It has long been recognized that psychological factors can contribute to the clinical picture of organic illness. This has been most forcefully demonstrated in the consideration of “hysteria” and hysterical symptoms. When the organic component has atypical features, and the proposed psychological explanation of illness is not clearly defined, doctors must be particularly alert that countertransference reactions do not intrude into the overall management and diagnostic processes.