The clinical diagnosis of pinealoma

In a review by Reiter, studies indicated that pineal tumors account for 4.8 percent of all childhood tumors in children under the age of 15 years. The incidence of pinealoma in boys is five times the occurrence in girls, with the mean age at diagnosis of 12 years. The most common presenting symptoms of a pinealoma are vomiting, headache, and eye findings indicating increased intracranial pressure. Other clinical findings are Parinaud's sign (paralysis of conjugate upward gaze), Argyle-Robertson pupil, diabetes insipidus and cerebellar ataxia. Calcification of the pineal in young children is considered pathognomonic for pinealoma. The least common symptom of pineal tumors was precocious puberty or delayed onset of sexual maturation. Diagnosis of pinealoma is most commonly made by pneumoencephalography or computerized tomography. However, since the advent of RIA techniques for sensitive measurements of serum and CSF melatonin, it is expected that this test may be used in the future for diagnosis. Assays of two pineal tumors have revealed markedly increased HIOMT activity which would suggest increased melatonin production by the tumors.