β-human chorionic gonadotropin-secreting intracranial germ-cell tumor associated with high testosterone in an adult man: A case report

Abstract

A 38-year-old male patient presented with general weakness, polydipsia and a body weight loss of 10 kg in two years. Hypopituitarism with central hypothyroidism and central adrenal insufficiency were noted at Taipei City Hospital (Taipei, Taiwan). However, hypogonadotropic hypergonadism was also observed. The patient was diagnosed with an intracranial β-human chorionic gonadotropin (β-hCG) secreting germ-cell tumor, and brain magnetic resonance imaging revealed that the tumor involved the pineal gland, stalk, posterior pituitary gland, right basal ganglion, hypothalamus, corpus callosum and posterior hippocampus. The cerebrospinal fluid (CSF) β-hCG level was 1936 IU/l, while the α-fetoprotein (AFP) level was <0.24 ng/ml. The serum AFP level of the patient was 3.28 ng/ml, and the β-hCG level was 178 IU/l with a CSF:serum β-hCG ratio >2:1. The patient was successfully treated with chemotherapy and radiotherapy, as demonstrated by a marked decrease in size of the tumor and in the serum β-hCG levels. Intracranial β-hCG secreting germ-cell tumors are rare in adults and manifest differently compared with patients of early pubertal age. In contrast with the precocious puberty frequently observed in young patients, the diagnosis of adult patients is often delayed and the symptoms are associated with tumor size and location. The present case report described an adult male with an intracranial β-hCG secreting GCT, demonstrating hypopituitarism and asymptomatic hyperandrogenemia, and reviews and discusses the literature relevant to the case.

Keywords: hypogonadotropic hypergonadism; intracranial germ-cell tumor; β-human chorionic gonadotropin.

Figure 1.

Magnetic resonance imaging of sella prior to treatment. Heterogeneous lesions are indicated by arrows and are present in the basal ganglion, hypothalamus, corpus callosum, posterior hippocampus, pineal gland, stalk and posterior pituitary gland in (A) non-contrast sagittal, (B) coronal, (C) contrast sagittal and (D) coronal T1 weighted images, as well as (E) T2 weighted sagittal and (F) coronal images.

Figure 2.

Magnetic resonance imaging of suprasella two years following treatment. The tumors over the basal ganglion, hypothalamus, corpus callosum, posterior hippocampus, pineal gland, stalk and posterior pituitary gland have disappeared, as indicated by arrows, in (A) non-contrast sagittal, (B) coronal, (C) contrast sagittal and (D) coronal T1 weighted images, as well as (E) T2 weighted sagittal and (F) coronal images.