case_images: PMC11156995_01
case_images: Magnetic resonance imaging (MRI); (A) axial T1 flair, (B) coronal T2, and (C) sagittal T1 flair images showing a rim-enhancing tumor mass likely arising from the Optic chiasm and extending into the third ventricle, the prepontine cistern, the interpeduncular cistern intermittent to the optic chiasm measuring 3.0 cm (AP) x 2.7 cm (CC) x1.8 cm (T). (D) Plain X-ray films, open frog leg view showing inferior displacement of the right femoral capital epiphysis (blue arrow) relative to the femoral neck associated with widening of the proximal femoral growth plate and minimal joint effusion. (E) Surgical pinning to stabilize the capital epiphysis on the right hip and prophylactic pinning to prevent SCFE on the left hip.
case_images: fonc-14-1399356-g001.jpg
case_images: PMC11156995_01_fonc-14-1399356-g001.jpg
case_images: f1
case_images: After stabilization, baseline MRI showed rim-enhancing mass arising from the optic chiasm with mass effect on the pituitary infundibulum and perilesional edema involving the splayed cerebral peduncles and bilateral hypothalamus ( Figures 1A-C ). Our patient developed hypothalamic obesity due to the location of the tumor and the perilesional edema involving the hypothalamus at presentation ( Figure 1C ). X-ray of the hips ( Figure 1D ) showed slipped capital femoral epiphysis (SCFE) of the right hip. Erdafitinib was discontinued, and he underwent surgery with in situ pinning of the right hip and prophylactic pinning of the left hip (to prevent SCFE) ( Figure 1E ).
case_images: Graphs showing BMI and rate of weight gain in our patient.
case_images: fonc-14-1399356-g002.jpg
case_images: PMC11156995_01_fonc-14-1399356-g002.jpg
case_images: f2
case_images: This was clinically manifested by a voracious insatiable appetite and accelerated rate of weight gain (82.1 kg->97% percentile for age and sex) ( Figure 2 ).