Beyond the tumor: endocrine and metabolic dysregulation in intracranial germ cell tumors – a retrospective cohort study

TL;DR

This study examines endocrine and metabolic complications in patients with intracranial germ cell tumors before and after treatment, highlighting the need for ongoing monitoring and early intervention.

Contribution

The study provides new insights into the long-term endocrine-metabolic effects of iGCT treatment, emphasizing the importance of monitoring and early intervention.

Findings

72.3% of patients required hormone replacement after treatment.

Overweight and obesity rates increased post-treatment.

Growth hormone deficiency and hypothyroidism were more prevalent after treatment.

Abstract

Intracranial germ cell tumors (iGCTs) often lead to endocrine-metabolic complications; however, their long-term effects are not well understood and characterized.

To evaluate endocrine-metabolic dysfunction before and after iGCTs treatment.

The present retrospective study included 99 patients with iGCTs treated at a tertiary hospital. Endocrine and metabolic parameters were assessed before and after treatment.

A male sex predominance was observed (81.8%). The leading site was pineal (44.4%), and 67.7% of the tumors were classified as germinoma. Radiotherapy was performed in 82.8% of the cases (58.5% cranial and 41.5% craniospinal). At diagnosis, the incidences of gonadotropin-independent precocious puberty and diabetes insipidus were 15.2% and 48.2%, respectively. Significant endocrine-metabolic changes in patients with iGCTs were observed after treatment, as 72.3% of patients required hormone replacement, 60% had growth hormone deficiency, and dyslipidemia was observed in 49.2% of patients. Overweight increased from 24.2 to 35.4% after treatment, while obesity increased from 10.1 to 15.4%. There was an increase in growth hormone deficiency, hypothyroidism, and hypogonadism, while prolactin levels significantly decreased after treatment. An older age at diagnosis was associated with a lower risk of hypocortisolism (
p
 = 0.005). Regarding sex, females had lower height Z-scores and a higher frequency of growth hormone deficiency compared with males. Tumor-related mortality was reported in 22.2% of patients, occurring on average 2.2 years postdiagnosis.

The high prevalence of endocrine-metabolic complications following radiotherapy highlights the necessity of ongoing monitoring. The treatment demonstrated significant efficacy, as reflected by the notable survival rates. Early intervention is crucial for improving the long-term quality of life.

Figures