Precocious puberty due to human chorionic gonadotropin secreting germinoma

Abstract

This study aims to report a rare case of precocious puberty (PP) due to a human chorionic gonadotropin (hCG)-producing germinoma located in the suprasellar region. A 10-year-old male patient presented with sexual precocity, headache, drowsiness, loss of appetite, and papilledema. Significant acceleration of bone age in relation to chronological age, high serum total testosterone levels, and hypopituitarism (unresponsiveness to stimulation test) were observed. Magnetic resonance imaging (MRI) of the brain showed a large suprasellar tumor and triventricular dilatation. High hCG levels were found in both blood and cerebrospinal fluid. Hormone replacement therapy and transcranial surgery associated with radiotherapy were performed, with complete regression of sexual characteristics and normal laboratory tests post-operatively. Clinical and laboratory findings, in addition to MRI scans, led to the diagnosis of an hCG-producing tumor and PP, which represents a rare report in the literature.

Keywords: Central nervous system neoplasms; chorionic gonadotropin; germinoma; precocious puberty.

Figure 1

Large, hyperintense suprasellar tumor, with hypodense areas inside, located in the anterior third ventricle, measuring 3 cm in the largest diameter (arrows) and causing triventricular dilatation

Figure 2

Uniform large tumor cells with large nuclei, prominent nucleoli, and abundant glycogen-rich cytoplasm are noted among reactive inflammatory cells and bands of connective tissue, supporting the diagnosis of germinoma