Water and Electrolyte Disturbances in Children after Surgery for Brain Tumors / 대한소아내분비학회지

PURPOSE: One of the most challenging problems associated with brain tumor surgery is the occurrence of water and electrolyte disturbances (WEDs) due to antidiuretic hormone (ADH) imbalance. This study was performed to investigate the incidence, risk factors and natural history of WEDs occurring after brain tumor surgery. METHODS: We analyzed the clinical course and laboratory records of children who showed WEDs after brain tumor operation at Severance Children's Hospital between February 2004 and February 2009. RESULTS: Fifty-two of 53 (20.0%) patients with WEDs (total, 265 cases) were diagnosed with diabetes insipidus (DI), and 1 patient was diagnosed with syndrome of inappropriate antidiuretic hormone secretion (SIADH). Eighteen patients had preoperative DI, which developed into a permanent condition. In another group of 34 patients, 7 had transient DI, while the remaining 27 patients, including 6 children with hyponatremia, showed progression to permanent DI. Among 30 patients with craniopharyngioma, 7 developed preoperative DI; 2, transient DI; and 15, postoperative permanent DI. Among 24 patients with germinoma, 8 showed preoperative DI; 1, transient DI; and 4, postoperative permanent DI. In addition, among 17 patients with pituitary adenoma, 3 developed transient DI and 3 others developed postoperative permanent DI. The incidence of WEDs was high (50.5%) in patients with the abovementioned tumors, especially among those with suprasellar or hypothalamic lesions. CONCLUSION: Careful postoperative monitoring for WEDs is necessary for patients who have been preoperatively diagnosed with DI or suprasellar or hypothalamic lesions. Further, we recommend that postsurgical reassessment for DI should be performed in patients showing symptoms of DI.

A Case of Langerhans Cell Histiocytosis Mimicking Periorbital Cellulitis / 소아감염

Langerhans cell histiocytosis is a rare disease in children. However, Langerhans cell histiocytosis encompasses a wide spectrum of clinical presentations and mimics other conditions. A 1-year-old boy presented with signs of periorbital cellulitis that initially responded to antibiotics, but remained as a same-sized mass with serial orbital computed tomography. The lesion was partially excised. Histopathology and immunohistochemical staining confirmed the diagnosis of Langerhans cell histiocytosis. This case demonstrates that in patients with periorbital cellulitis which has relapsed or responded inadequately to antibiotics, further investigation should initiated to rule out other inflammatory causes.