The primary intracranial endodermal sinus tumor (EST) is regarded as a rare histological subtype that is often associated with components of other germ cell tumors, and there are no reports on the onset of intracranial ESTs after growth hormone (GH) replacement therapy. The authors report an extremely rare case of pure primary EST associated with GH replacement therapy. A 15-year-old girl with GH deficiency experienced headache, nausea, and vomiting after GH replacement therapy for a 17-month period. Magnetic resonance imaging showed 2 tumor masses located in the pineal region and frontal horn of the right lateral ventricle, respectively. Before surgery, the authors administered 1 cycle of neoadjuvant chemotherapy, which shrank the tumor and facilitated surgical intervention. The larger mass located in the pineal region was removed via a right occipital transtentorial approach, and postoperative histopathological analysis revealed a pure EST. While there is a clear association between the initiation of GH replacement therapy and the development of the EST in this case, the causal effect cannot be specified. Nevertheless, this case demonstrates that GH replacement therapy must be used cautiously.
Abbreviations used in this paper: AFP = α-fetoprotein; EST = endodermal sinus tumor; GH = growth hormone; IFG-I = insulin-like growth factor–I.
Address correspondence to: Xiang'en Shi, M.D., Ph.D., Department of Neurosurgery, Fu Xing Hospital, Capital Medical University, No. 20 Fu Xing Menwai Street, Xicheng District, Beijing 100038, People's Republic of China. email: email@example.com.
Please include this information when citing this paper: DOI: 10.3171/2011.10.PEDS1195.
AttanasioAFBatesPCHoKKWebbSMRossRJStrasburgerCJ: Human growth hormone replacement in adult hypopituitary patients: long-term effects on body composition and lipid status—3-year results from the HypoCCS Database. J Clin Endocrinol Metab87:1600–16062002
ChristiansenJSBengtssonBAThornerMOHintzRSonksenPHCohenP: Critical evaluation of the safety of recombinant human growth hormone administration: statement from the Growth Hormone Research Society. J Clin Endocrinol Metab86:1868–18702001
GiovannucciEPollakMNPlatzEAWillettWCStampferMJMajeedN: A prospective study of plasma insulinlike growth factor-1 and binding protein-3 and risk of colorectal neoplasia in women. Cancer Epidemiol Biomarkers Prev9:345–3492000
GötherströmGSvenssonJKoranyiJAlpstenMBosaeusIBengtssonB: A prospective study of 5 years of GH replacement therapy in GH-deficient adults: sustained effects on body composition, bone mass, and metabolic indices. J Clin Endocrinol Metab86:4657–46652001
HatrickAGBoghaloPBinghamJBAyresABSonksenPHRussell-JonesDL: Does GH replacement therapy in adult GH-deficient patients result in recurrence or increase in size of pituitary tumours?. Eur J Endocrinol146:807–8112002
HoKKY: Consensus guidelines for the diagnosis and treatment of adults with GH deficiency II: a statement of the GH Research Society in association with the European Society for Pediatric Endocrinology, Lawson Wilkins Society, European Society of Endocrinology, Japan Endocrine Society, and Endocrine Society of Australia. Eur J Endocrinol157:695–7002007
KochiMItoyamaYShiraishiSKitamuraIMarubayashiTUshioY: Successful treatment of intracranial nongerminomatous malignant germ cell tumors by administering neoadjuvant chemotherapy and radiotherapy before excision of residual tumors. J Neurosurg99:106–1142003
TeilumG: Endodermal sinus tumors of the ovary and testis. Comparative morphogenesis of the so-called mesoephroma ovarii (Schiller) and extraembryonic (yolk sac-allantoic) structures of the rat's placenta. Cancer12:1092–11051959
UshioYKochiMKuratsuJItoyamaYMarubayashiT: Preliminary observations for a new treatment in children with primary intracranial yolk sac tumor or embryonal carcinoma. Report of five cases. J Neurosurg90:133–1371999