Hypothalamic hamartoma


  • An 14 years old girl
  • Presented with central precocious puberty since infancy
  • Also had epilepsy on antiepileptics and psychosis on treatment
  • Operation done at one year of age
  • HPE confirmed hypothalamic hamartoma.
  • MRI for reassessment
MRI of brain in axial planes; (a) FLAIR, (b) T1WI and (C) T2WI sequences


MRI of brain in sagittal plane; (d) T1WI, (E) T2WI and (F) T1+Gadolinium sequences


MRI brain in coronal plane

MRI findings:

  • The is an ovoid mass arising from the right side of the hypothalamus/tuber cinereum (yellow arrows)
  • The lesion measures 1.7 x 1.5 x 1.6 cm, no change compared to previous scan
  • This mass is isointense to grey matter in all sequences. There is no significant enhancement seen post gadolinium.
  • The mass indented the 3rd ventricle anteriorly. However, it does not cause obstructive hydrocephalus.
  • No compression to the optic nerve and optic chiasm
  • The pituitary gland, pituitary infundibulum and the optic chiasma are normal.

Diagnosis: Hypothalamic hamartoma (HPE proven)


  • Hypothalamic hamartoma also known as tuber cinereum hamartoma
  • It is non-neoplastic congenital gray matter heterotopia in region of tuber cinereum
  • Lesions can cause gelastic seizures, visual problems, early onset of puberty and behavioural problems as seen in this case
  • Best imaging modality is MRI and seen as non enhancing hypothalamic mass, similar density and intensity to gray matter
  • It may be sessile or pedunculated


Author: radhianahassan