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CC BY 4.0 · Arq Neuropsiquiatr 2025; 83(10): s00451812300
DOI: 10.1055/s-0045-1812300
Original Article

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

Authors

  • Mayco José Reinaldi Serra 

    1   Universidade Federal de São Paulo, São Paulo SP, Brazil.
    2   Universidade Lusiada, Santos SP, Brazil.
    3   Grupo de Apoio ao Adolescente e à Criança com Câncer, São Paulo SP, Brazil.

  • Angela Maria Spinola-Castro 

    1   Universidade Federal de São Paulo, São Paulo SP, Brazil.
    3   Grupo de Apoio ao Adolescente e à Criança com Câncer, São Paulo SP, Brazil.

  • Nasjla Saba da Silva 

    3   Grupo de Apoio ao Adolescente e à Criança com Câncer, São Paulo SP, Brazil.

  • Andrea Cappellano 

    3   Grupo de Apoio ao Adolescente e à Criança com Câncer, São Paulo SP, Brazil.

  • Paola Matiko Martins Okuda 

    1   Universidade Federal de São Paulo, São Paulo SP, Brazil.

  • Adriana Aparecida Siviero-Miachon 

    1   Universidade Federal de São Paulo, São Paulo SP, Brazil.
    3   Grupo de Apoio ao Adolescente e à Criança com Câncer, São Paulo SP, Brazil.

Funding The authors declare that the present study was funded by Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES), Brazil.
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Abstract

Background

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

Objective

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

Methods

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

Results

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.

Conclusion

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.

Keywords

Germinoma - Central Nervous System Diseases - Hypopituitarism - Obesity - Diabetes Insipidus - Radiotherapy

Authors' Contributions

Conceptualization: MJRS, AMSC, NSS, AC, PMMO, ASSM; Data curation: MJRS, AMSC, PMMO, ASSM; Formal analysis: MJRS, AMSC, PMMO, ASSM; Funding acquisition: MJRS, AMSC, ASSM; Investigation: MJRS, AMSC, ASSM; Methodology: MJRS, AMSC, PMMO, ASSM; Project administration: MJRS, AMSC, ASSM; Resources: MJRS, AMSC, ASSM; Software: MJRS, AMSC, PMMO, ASSM; Supervision: MJRS, AMSC, NSS, AC, PMMO, ASSM; Validation: MJRS, AMSC, PMMO, ASSM; Visualization: MJRS, AMSC, PMMO, ASSM; Writing – original draft: MJRS, AMSC, NSS, AC, PMMO, ASSM; Writing – review & editing: MJRS, AMSC, NSS, AC, PMMO, ASSM.


Data Availability Statement

The datasets generated and analyzed during the current study are not publicly available due to ongoing manuscript submissions but are available from the corresponding author upon reasonable request. All relevant research materials, including the codebooks and analysis scripts, were prepared for sharing and distribution. The corresponding author will provide these materials through a secure, anonymized database.


Editor-in-Chief: Hélio A. G. Teive (0000-0003-2305-1073).


Associate Editor: Suzana Maria Fleury Malheiros (0000-0003-3433-6867).




Publication History

Received: 23 April 2025

Accepted: 02 August 2025

Article published online:
27 October 2025

© 2025. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution 4.0 International License, permitting copying and reproduction so long as the original work is given appropriate credit (https://creativecommons.org/licenses/by/4.0/)

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Bibliographical Record
Mayco José Reinaldi Serra, Angela Maria Spinola-Castro, Nasjla Saba da Silva, Andrea Cappellano, Paola Matiko Martins Okuda, Adriana Aparecida Siviero-Miachon. Beyond the tumor: endocrine and metabolic dysregulation in intracranial germ cell tumors – a retrospective cohort study. Arq Neuropsiquiatr 2025; 83: s00451812300.
DOI: 10.1055/s-0045-1812300