Abstract
We report a male patient with hypothalamic hamartoma (HH) who manifested central precocious puberty (CPP) at 4years of age. Gonadotropin-releasing hormone (GnRH) analogue treatment was started at 6years of age and his pubertal signs were suppressed. At 9years 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 8months from 9years and 4months 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 3months 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.
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