Severe panhypopituitarism as the primary manifestation of suprasellar–pineal germinoma: A case report

Suprasellar–pineal germinoma is a midline tumor that can cause disruption of the hypothalamic–pituitary axis through infiltration or compression of the pituitary stalk, leading to panhypopituitarism with broad metabolic manifestations. Involvement of the pineal region may also result in obstructive hydrocephalus, further worsening neuroendocrine dysfunction through increased intracranial pressure. Diagnosis is established through the integration of radiological findings, hormonal evaluation, and histological, while management requires a combination of oncologic therapy and long-term hormone replacement. A 21-year-old man presented with a seizure and a six-month history of progressive endocrine symptoms, including fatigue, cold intolerance, decreased libido, and reduced body hair. Hormonal assessment revealed severe panhypopituitarism, and MRI demonstrated a bifocal suprasellar–pineal tumor with obstructive hydrocephalus. The patient underwent VP shunt placement, craniotomy, and histopathological examination, which confirmed germinoma with positive CD117 and PLAP expression. Radiotherapy at a total dose of 40 Gy resulted in complete radiological remission; however, endocrine dysfunction persisted, necessitating long-term hormone replacement therapy. Follow-up evaluation showed hormonal improvement and clinical stability without tumor recurrence. This case highlights that suprasellar–pineal germinoma can present with severe panhypopituitarism and hydrocephalus as primary manifestations, underscoring the importance of vigilance toward progressive endocrine symptoms in young patients. Optimal management requires a multidisciplinary approach involving neurological stabilization, oncologic therapy, and long-term hormone replacement with careful metabolic monitoring to prevent complications and ensure sustained clinical stability. • Suprasellar–pineal germinoma may initially manifest as severe panhypopituitarism, with progressive endocrine symptoms preceding the onset of classical neurological signs. • Bifocal involvement of the suprasellar and pineal regions results in disruption of the hypothalamic–pituitary axis and obstructive hydrocephalus, further exacerbating neuroendocrine dysfunction. • The diagnosis is established through the integrated approach combining MRI findings, hormonal profiling, and histopathological and immunohistochemical confirmation, including positive CD117 and PLAP expression. • Radiotherapy achieved complete radiological remission; however, endocrine damage is permanent, necessitating long-term hormone replacement therapy.