Pituitary Stalk Germ Cell Tumors: Retrospective Case Series and Literature Review

Sabatino, María Eugenia; Petiti, Juan Pablo; Xu, Yun; Zhong, Liyong

doi:10.1155/2022/9213220

Cited by 3 publications

(4 citation statements)

References 30 publications

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“…In the present study, although the differences in neuroendocrine outcomes are not significant between subtypes 1 and 2, it could be predicted that patients with the subtype 1 and 2 images would have better neuroendocrine outcomes than those with non-sellar patients. Combined with the previous study on pituitary stalk GCT ( 16 ), this study indicated that a limited sellar iGCT located in the pituitary and the floor of the third ventricle, including solitary and bifocal lesions, has the potential to spontaneously improve neuroendocrine outcomes. Hence, it is valuable evidence to support the role of sellar lesion image in predicting neuroendocrine outcomes and in administrating individual hormone replacement treatment.…”

Section: Discussionsupporting

confidence: 64%

Comparison of different predominant lesions in intracranial bifocal germ cell tumors to predict neuroendocrine outcomes

Liang

Sabatino²,

Zhong

2023

Endocrine Connections

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Purpose: Intracranial germ cell tumors frequently arise from midline of brain, occasionally presenting as bifocal diseases. The predominant lesion might affect clinical characteristics and neuroendocrine outcomes. Method: A retrospective cohort study involving 32 patients with intracranial bifocal germ cell tumors was performed. Result: Eighteen patients (8 males and 10 females) were assigned into sellar-predominant type, including 7 patients without hypothalamic involvement and 11 with. Fourteen patients (12 males and 2 females) presenting with an isolated pituitary stalk lesion in sellar region were assigned into pineal-predominant type. The difference in the sex ratio was significant (p=0.017), but not in manifestations(p=0.493) or symptom intervals (p=0.999). Before treatment, central diabetes insipidus was reported in 29 patients, while hypopituitarism was reported in 27 patients, without significant differences between different types. At the end of therapy, pineal-predominant patients had significantly lower incidences in hypothalamic-pituitary-gonadal impairment and growth hormone/insulin-like growth factor-1 impairment than those of sellar-predominant patients (p=0.001 and 0.017, respectively), as well as at the final follow-up visit (p=0.001 and 0.013, respectively). Pineal-predominant patients also had lower incidences of central diabetes insipidus, hypothalamic-pituitary-adrenal impairment, hypothalamic-pituitary-thyroid impairment and hyperprolactinemia than those of sellar predominant patients at the end of therapy and the final follow-up visit, without obvious differences. Conclusion: Neuroendocrine disorders are common in patients with bifocal intracranial germ cell tumors, similarly in different predominant lesions. After the elimination of tumor, patients with pineal-predominant lesion have a greater potential of spontaneous recovery, as well as a better neuroendocrine outcome than those of sellar-predominant patients.

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Section: Discussionsupporting

confidence: 64%

Comparison of different predominant lesions in intracranial bifocal germ cell tumors to predict neuroendocrine outcomes

Liang

Sabatino²,

Zhong

2023

Endocrine Connections

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“…Scarce data is available to compare sex-speci c differences in patients with GCT and PST. Chen et al published a case series of patients with GCT with isolated pituitary stalk involvement and described eleven patients in a period of six years (2015-2021) with no signi cant differences in sex [5]. However, GCT are described more frequently in males than females, with a ratio of about 4 to 1 [10].…”

Section: Discussionmentioning

confidence: 99%

“…The most frequent clinical manifestations are anterior pituitary dysfunction, AVD, visual eld de cits and signs of elevated intracranial pressure. Regarding pituitary dysfunction, the most common clinical presentation is polyuria and polydipsia [5]. AVD is very common and other anterior pituitary hormone de cits occur in half of the patients [2,6].…”

Section: Introductionmentioning

confidence: 99%

Changes in the epidemiological profile of pituitary stalk thickening among pediatric population in Chile during COVID-19 pandemic

Zepeda

Guarda

Okuma

et al. 2023

Preprint

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Purpose Pituitary stalk thickening (PST) is a rare disease affecting mainly adults. Pediatric cases are infrequent. The aim of this study is to evaluate the frequency of pediatric patients with PST during the pandemic outbreak of COVID-19 in Chile and compare it with previous data. Methods A retrospective chart review was conducted in patients with PST diagnosed during COVID-19 outbreak. Patients <18 years with pituitary stalk width of 3mm or more at pituitary insertion and/or 4mm or more at optic chiasm were included. In order to characterize and compare these cases with those already published, a review of the literature was performed. Results Nine patients were diagnosed with PST. Seven were girls. Mean age at the onset of symptoms was 10.36 years (2.4-17). Germinal cell tumors (GCT) were diagnosed in 8 patients and Langerhans cell histiocytosis in one. All patients had negative tumor markers, arginine-vasopressin deficiency (AVD) and at least one anterior pituitary hormonal deficit at diagnosis. Diagnoses were confirmed histologically in all patients, and four required a second biopsy. We found a frequency of 4 patients per year with PST due to GCT which is twice the one expected in the same population in Chile. Conclusion A surprisingly high frequency of PST presented during the COVID-19 pandemic among Chilean pediatric patients, being GCT the most frequent etiology. The reasons behind this increase in reported cases are still to be elucidated.

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“…The pituitary stalk connects the median eminence of the hypothalamus to the pituitary gland [1]. Pathologies involving the pituitary stalk may present with hormonal deficiencies, precocity and non-specific symptoms such as headache and visual disturbance [2][3][4][5][6]. Isolated pituitary stalk thickening (PST) may be a result of neoplasms, such as germ cell tumors (GCTs) and Langerhans cell histiocytosis (LCH), inflammation, infection or congenital variants or can be idiopathic [6][7][8][9][10][11][12][13][14][15].…”

Section: Introductionmentioning

confidence: 99%

Incidence and Predictors for Oncologic Etiologies in Chinese Children with Pituitary Stalk Thickening

Li¹,

Poon

Cheung³

et al. 2023

Cancers

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Background: With the increasing use of magnetic resonance imaging (MRI) in the evaluation of children with endocrine disorders, pituitary stalk thickening (PST) poses a clinical conundrum due to the potential for underlying neoplasms and challenges in obtaining a tissue biopsy. The existing literature suggests Langerhans cell histiocytosis (LCH) to be the commonest (16%) oncologic cause for PST, followed by germ cell tumors (GCTs, 13%) (CCLG 2021). As the cancer epidemiology varies according to ethnicity, we present herein the incidence and predictors for oncologic etiologies in Hong Kong Chinese children with PST. Methods: Based on a territory-wide electronic database, we reviewed patients aged < 19 years who presented to three referral centers with endocrinopathies between 2010 and 2022. Records for patients who underwent at least one MRI brain/pituitary were examined (n = 1670): those with PST (stalk thickness ≥ 3 mm) were included, while patients with pre-existing cancer, other CNS and extra-CNS disease foci that were diagnostic of the underlying condition were excluded. Results: Twenty-eight patients (M:F = 10:18) were identified. The median age at diagnosis of PST was 10.9 years (range: 3.8–16.5), with central diabetes insipidus (CDI) and growth hormone deficiency (GHD) being the most frequent presenting endocrine disorders. At a median follow-up of 4.8 years, oncologic diagnoses were made in 14 patients (50%), including 13 GCTs (46%; germinoma = 11, non-germinoma = 2) and one LCH (4%). Among patients with GCTs, 10 were diagnosed based on histology, two by abnormal tumor markers and one by a combination of histology and tumor markers. Three patients with germinoma were initially misdiagnosed as hypophysitis/LCH. The cumulative incidence of oncologic diagnoses was significantly higher in boys and patients with PST at presentation ≥6.5 mm, CDI or ≥2 pituitary hormone deficiencies at presentation and evolving hypopituitarism (all p < 0.05 by log-rank). Conclusions: A higher rate of GCTs was observed in Chinese children with endocrinopathy and isolated PST. The predictors identified in this study may guide healthcare providers in Asia in clinical decision making. Serial measurement of tumor markers is essential in management.

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Pituitary Stalk Germ Cell Tumors: Retrospective Case Series and Literature Review

Cited by 3 publications

References 30 publications

Comparison of different predominant lesions in intracranial bifocal germ cell tumors to predict neuroendocrine outcomes

Comparison of different predominant lesions in intracranial bifocal germ cell tumors to predict neuroendocrine outcomes

Changes in the epidemiological profile of pituitary stalk thickening among pediatric population in Chile during COVID-19 pandemic

Incidence and Predictors for Oncologic Etiologies in Chinese Children with Pituitary Stalk Thickening

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