title: Rapid enlargement of an intracranial germ cell tumor after gonadotropin hormone therapy.
abstract: We report a case of an intracranial germ cell tumor (iGCT) that showed rapid enlargement after human chorionic gonadotropin (hCG) hormone therapy for pituitary hypogonadism. A 16-year-old boy presented with headache and was diagnosed with a suprasellar tumor. He was initially observed without surgery. Intranasal desmopressin therapy was started for central diabetes insipidus, but there was no change in the tumor size on MRI. The diagnosis of the tumor remained unknown for 4years. Levels of serum gonadotropin hormones (follicle-stimulating and luteinizing hormone) and testosterone progressively decreased, and the patient developed pituitary hypogonadism and complained about his undeveloped beard, lack of underarm hair, and erectile dysfunction. Intramuscular gonadotropin injection (hCG 5000U×2/week) was started at age 20. Eight months after the first gonadotropin injection, the MRI showed tumor growth with vivid enhancement. Craniotomy was performed and the tumor was partially resected. The histological diagnosis was immature teratoma. After surgery, the patient was treated with 5 cycles of chemotherapy with carboplatin and etoposide. He also received radiation therapy of 50Gy (20Gy tumor bed and 30Gy whole ventricles) to the residual tumor, after which the tumor decreased in size. We postulate that iGCT may be at risk of progression during hCG hormone therapy. Thus, careful monitoring is required for a patient with iGCT who receives this therapy.
authors.affiliation: Department of Neurosurgery, Kanazawa Medical University, 1-1 Daigaku, Uchinada 920-0293, Ishikawa, Japan. Electronic address: yacchan1218@yahoo.co.jp.
authors.forename: Yasuo
authors.initials: Y
authors.lastname: Sasagawa
authors.affiliation: Department of Neurosurgery, Kanazawa Medical University, 1-1 Daigaku, Uchinada 920-0293, Ishikawa, Japan.
authors.forename: Osamu
authors.initials: O
authors.lastname: Tachibana
authors.affiliation: Department of Diabetology and Endocrinology, Kanazawa Medical University, Ishikawa, Japan.
authors.forename: Athushi
authors.initials: A
authors.lastname: Nakagawa
authors.affiliation: Department of Pathology and Laboratory Medicine, Kanazawa Medical University, Ishikawa, Japan.
authors.forename: Satoko
authors.initials: S
authors.lastname: Nakada
authors.affiliation: Department of Pathology and Laboratory Medicine, Kanazawa Medical University, Ishikawa, Japan.
authors.forename: Takayuki
authors.initials: T
authors.lastname: Nojima
authors.affiliation: Department of Diabetology and Endocrinology, Kanazawa Medical University, Ishikawa, Japan.
authors.forename: Daisuke
authors.initials: D
authors.lastname: Koya
authors.affiliation: Department of Neurosurgery, Kanazawa Medical University, 1-1 Daigaku, Uchinada 920-0293, Ishikawa, Japan.
authors.forename: Hideaki
authors.initials: H
authors.lastname: Iizuka
mesh_terms: D000293:Adolescent; D001932:Brain Neoplasms / Q000000981:diagnostic imaging* / Q000209:etiology / Q000473:pathology; D006063:Chorionic Gonadotropin / Q000009:adverse effects* / Q000627:therapeutic use; D020249:Hormone Replacement Therapy / Q000009:adverse effects*; D006801:Humans; D007006:Hypogonadism / Q000188:drug therapy*; D008279:Magnetic Resonance Imaging; D008297:Male; D010902:Pituitary Gland / Q000378:metabolism; D013724:Teratoma / Q000000981:diagnostic imaging* / Q000209:etiology / Q000473:pathology
chemical_list: D006063:Chorionic Gonadotropin
keywords: Gonadotropin hormone therapy; Growth; Intracranial germ cell tumor