Pineal germinoma – hypogonadism issues

Abstract

Introduction. Pineal tumors are an inhomogeneous group of lesions with pineal origin, characterized by various degrees of hypothalamic-pituitary dysfunction. Case presentation. We present the case of a patient with pineal germinoma and hypogonadotropic hypogonadism who was evaluated in several medical centers. A 31-year-old male patient with a history of primary hypothyroidism and pineal germinoma, for which he underwent surgery, radiation and chemotherapy, was admitted for frontal-temporal headache, nausea and moderate intensity asthenia. Clinical examination revealed normal weight, normal blood pressure, left eye strabismus, pale skin, diminished facial and body hair, bilateral gynecomastia. The endocrine profile showed adequate thyroid hormone replacement, low normal basal cortisol levels (5.88 µg/dL, normal 5-25 µg/dL), low IGF-1 (Insulin-like Growth Factor) (93.2 pg/mL, normal 115-307 pg/mL), low gonadotrophins, testosterone (0.57 ng/mL, normal 1.3-8.53 ng/mL) and estradiol (<10 pg/mL, normal 15-60 pg/mL). Breast ultrasound showed bilateral asymmetric gynecomastia, BIRADS-2. No tumors or surgery complications were found on MRI (Magnetic Resonance Imaging) exam. A diagnosis of hypogonadotropic hypogonadism was established and surgical cure of gynecomastias, as well as testosterone replacement therapy were recommended. Conclusions. Pineal germinomas are rare tumors associated with increased risk of endocrine dysfunctions, including hypogonadotropic hypogonadism, as a consequence of germinoma-specific therapy. Frequent biochemical assessment as well as follow-up imaging are needed, in order to prevent tumor recurrence and long-term complications related to the germinoma itself or the chosen therapy.

Keywords

• germinoma
• hypogonadism
• gynecomastia