The clinical presentation varies between children and adults. Craniopharyngiomas are slow-growing tumors and hence may reach considerable size before diagnosis. Children will often tolerate marked visual deterioration and hydrocephalus before they complain. Nonspecific symptoms such as poor school performance, poor memory (hypothalamic compression) and disruptive behavior may go unnoticed. The endocrine features are manifest in short stature, delayed puberty, hyperphagia and obesity (this may be a prominent postoperative feature), and other behavioral problems. DI is less common. Adults present mainly with varying degrees of visual failure. Hydrocephalus at presentation is relatively rare, but neurobe-havioral syndromes unrelated to hydrocephalus are relatively common, including confusion, dementia and hypersomnia. The most common endocrinopathy in adults is gonadal failure, presenting as secondary amenorrhea in women and loss of libido in males.
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