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Craniopharyngioma

Last reviewed: 9 Dec 2025
Last updated: 06 Jan 2026

Summary

Definition

History and exam

Key diagnostic factors

  • visual loss
  • macrocephaly and hydrocephalus
  • faltering growth
Full details

Other diagnostic factors

  • symptoms of hypogonadotropic hypogonadism (amenorrhea, erectile dysfunction)
  • headache
  • symptoms of intracranial hypertension (nausea, vomiting, decreased sensorium, diplopia)
  • galactorrhea
  • optic atrophy
  • polyuria/polydipsia
Full details

Risk factors

  • age 5 to 14 years
  • age 50 to 70 years
Full details

Diagnostic tests

1st tests to order

  • ophthalmologic evaluation; computerized visual-field examination
  • MRI brain (contrast-enhanced)
  • CT brain (contrast-enhanced)
  • serum prolactin
  • serum insulin-like growth factor 1
  • growth hormone (GH) stimulation test
  • serum luteinizing hormone
  • serum follicle-stimulating hormone
  • morning serum testosterone
  • serum thyroid-stimulating hormone (TSH) and free thyroxine (FT4)
  • morning serum cortisol and adrenocorticotropic hormone (ACTH)
  • serum electrolytes
  • urine and serum osmolality
  • plain x-rays for bone age
Full details

Tests to consider

  • adrenocorticotropic hormone (ACTH) stimulation test
  • tissue histology
Full details

Treatment algorithm

ACUTE

at initial treatment

ONGOING

post initial treatment

Contributors

Authors

Olabisi Sanusi, MD

Assistant Professor (Skull Base and Open cerebrovascular)

Departments of Neurosurgery, Otolaryngology

Director of Diversity, Equity, and Inclusion

Co-director Skull base fellowship

Oregon Health & Science University

Portland

OR

Disclosures

OS has given lectures related to Craniopharyngioma at the Congress of Neurological Surgeons meeting 2023, and will be giving another at the National Association of Skull Base Surgeons Meeting 2025.

Acknowledgements

Dr Olabisi Sanusi would like to gratefully acknowledge Dr Marc C. Chamberlain and Dr Daniel L. Silbergeld, the previous contributors to this topic.

Disclosures

MCC and DLS declare that they have no competing interests.

Peer reviewers

Edwin S. Kulubya Jr., MD, MBA

Neurosurgical Research Fellow

UC Davis Medical Center

Sacramento

CA

Disclosures

EK declares that he has no competing interests.

Ramez Kirollos, MBChB, FRCS(Ed), FRCS(Eng), MD, FRCS(SN)

Consultant Neurosurgeon

Addenbrooke's Hospital

Cambridge University Hospitals NHS Foundation Trust

Cambridge

UK

Disclosures

RK declares that he has no competing interests.

Keyoumars Ashkan, BA, BSc, MB BCh, MRCP, FRCS, FRCPS, FRCS(SN), MD

Consultant Neurosurgeon and Lead of Neuro-Oncology

King's College Hospital

London

UK

Disclosures

KA declares that he has no competing interests.

Peer reviewer acknowledgements

BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.

Disclosures

Peer reviewer affiliations and disclosures pertain to the time of the review.

References

Our in-house evidence and editorial teams collaborate with international expert contributors and peer reviewers to ensure that we provide access to the most clinically relevant information possible.

Key articles

Louis DN, Perry A, Wesseling P, et al. The 2021 WHO classification of tumors of the central nervous system: a summary. Neuro Oncol. 2021 Aug 2;23(8):1231-51.Full text  Abstract

Karavitaki N, Cudlip S, Adams CB, et al. Craniopharyngiomas. Endocr Rev. 2006 Jun;27(4):371-97. Abstract

Gan HW, Morillon P, Albanese A, et al. National UK guidelines for the management of paediatric craniopharyngioma. Lancet Diabetes Endocrinol. 2023 Sep;11(9):694-706. Abstract

Hoffman LM, Jaimes C, Mankad K, et al. Response assessment in pediatric craniopharyngioma: recommendations from the Response Assessment in Pediatric Neuro-Oncology (RAPNO) Working Group. Neuro Oncol. 2023 Feb 14;25(2):224-33.Full text  Abstract

Reference articles

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
  • Craniopharyngioma images
  • Differentials

    • Pituitary adenoma
    • Diaphragmatic meningioma
    • Chiasmatic epidermoid
    More Differentials
  • Guidelines

    • Response assessment in pediatric craniopharyngioma: recommendations from the Response Assessment in Pediatric Neuro-Oncology (RAPNO) Working Group
    • National UK guidelines for the management of paediatric craniopharyngioma
    More Guidelines
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