Endocrine Abstracts

Background: Intracranial Germ Cell Tumors (GCTs) are thought to originate from error of primordial germ cells migration during embryonic development, manifesting during first and second decade of life and accounts for 3-5% of all intracranial tumors.

Methods: We report a case of a 22-year-old patient who presented with progressive visual loss with polyuria and polydipsia, harboring an intracranial germ cell tumor.

Case presentation: A 22 years old female presented initially to neurosurgery clinic and then referred to endocrine clinic, with history of a chronic worsening headache and recent onset visual blurring along with polyuria with polydipsia. On further inquiry she was found to have primary amenorrhea, easy fatiguability and failure of development of secondary sexual characteristics. There was no history of galactorrhea, hirsutism or any significant family history. On examination patient had bitemporal hemianopia with breast development at tanner stage II and pubic and axillary hair at tanner stage I. Her initial hormonal workup was suggestive of panhypopituitarism with diabetes insipidus. MRI Pituitary showed a seller mass with suprasellar extension inseparable from the pituitary stalk, so an initial impression of a pituitary macroadenoma vs a pituitary stalk tumor was made and patient underwent transsphenoidal surgery. The histopathology suggestive of a germinoma, a germ cell tumor and a rare cause of panhypopituitarism. She was stated on chemotherapy followed by radiotherapy, after which her tumor size has reduced significantly.

Conclusion: Pituitary stalk lesions are rare, and their definite diagnosis is challenging as different etiologies presents clinically and radiologically in a similar manner with tissue diagnosis being the gold standard.