Endocrine Abstracts

JOINT1685

Introduction: Intracranial germinomas is a rare and hardly distinguishable malignancy, it presents 3% of brain tumours in children and adolescents. The clinical presentation primarily depends on the tumor’s location, size, and the patient’s age. This report presents a 2 cases of suprasellar germinomas.

Case presentation: Case 1: A 13-year-old patient with no significant medical history consulted at the emergency department for intracranial hypertension syndrome, ptosis, strabismus of the left eye by bilateral visual acuity decline, polyuria and polydipsia. Brain MRI revealed lesional formation in the sellar region extending suprasellarly, measuring 21×18×16 mm, in contact with the cavernous sinus and both internal carotid arteries, it infiltrates the optic chiasm and the terminal part of the right optic nerve. Additionally, there is a lesion in the mesencephalic tegmentum and pons, surrounded by edema, measuring 26×15 mm, along with a pineal gland formation measuring 14×11 mm, consistent with an extended germinoma with triple localization. Hormonal tests showed thyrotropic and corticotropic deficiencies (8 a.m. cortisol :1.54 µg/dl, FT4 :7.7 pmol/l(range: 9- 19 pmol)); FSH<0.1mIU/ml, LH: 0.1 mUI/ml. The study of tumor markers in the cerebrospinal fluid (CSF) and the biopsy of the tumor was indicative of a germinoma. Case 2: A 12-year-and-11-month-old patient complained of intermittent headaches for 1 year, associated with polydysptic polyuria, diplopia and recent weight loss, as well as intermittent constipation. Three months later, the clinical presentation worsened with signs of increased intracranial pressure. Brain MRI Imaging revealed a bifocal lesion measuring 53×34 mm, predominantly suprasellar, infiltrating the midbrain and extending to the pineal region. It had intimate contact with the optic chiasm, both middle cerebral arteries, and infiltrated the floor of the third ventricle, as well as the midbrain and pineal region posteriorly. Hormonal assessment revealed: FSH: 0.1 mIU/ml; LH: <0.1 mIU/ml; PRL: 100 ng/ml, FT4: 7.13 pmol/l(range: 9- 19 pmol), 8 a.m cortisol: 2,26µg/dl. The analysis of CSF supported the diagnosis of a germinoma.

Discussion/Conclusion: Suprasellar germinomas typically present with hypothalamic-pituitary dysfunction, most commonly manifesting as diabetes insipidus (DI). Endocrine disturbances appeared well before the onset of neurological symptoms and DI. Early diagnosis is essential and should be based on a rigorous evaluation of the patient’s medical history, hormonal profile, laboratory results, and radiological findings. Early recognition is critical, as timely radiation and/or chemotherapy can significantly improve tumor outcomes.