ID #873 When Short Stature Signals Danger in Children: A Case of Suprasellar Germinoma
Ludi Dhyani Rahmartani, Ghaisani Fadiana, Aman Bhakti Pulungan, Mohamad Yanuar Amal, Endang Nuryadi, Eka Susanto, David TandianAbstract
Background
Intracranial germ cell tumors (GCTs) are rare pediatric neoplasms, with a higher incidence in Asia (8–14%). Approximately 10–20% arise in the suprasellar region. Clinical presentation is often subtle and nonspecific, frequently leading to delayed diagnosis. Endocrine dysfunction may precede neurological symptoms, and isolated growth failure can be an early but underrecognized sign.
Objective
To highlight short stature as a potential sole presenting feature of suprasellar germinoma and to emphasize the importance of comprehensive endocrine evaluation and multidisciplinary management.
Case
An 11-year-old girl was referred for short stature with documented growth arrest over one year. Physical examination revealed height below the 3rd percentile with normal body proportions. Pubertal staging was M1P1, and neurological examination was unremarkable. Chromosomal analysis was normal. Bone age was delayed by two years compared with chronological age. Endocrine evaluation showed low insulin-like growth factor-1 and low free thyroxine with inappropriately normal thyroid-stimulating hormone. Growth hormone stimulation testing demonstrated peak growth hormone levels below 10 ng/mL, consistent with multiple pituitary hormone deficiency. Contrast-enhanced brain MRI revealed a solid mass with cystic components in the sellar–suprasellar region extending to the pituitary stalk and compressing the optic chiasm. The diagnosis of suprasellar germinoma was confirmed by tumor markers, histopathology, and immunohistochemistry. The patient was managed through a multidisciplinary team involving pediatric oncology, endocrinology, neurosurgery, and radiation oncology. Post-chemoradiotherapy MRI demonstrated significant tumor volume reduction.
Conclusion
Short stature may be the only initial manifestation of a suprasellar brain tumor. Neuroimaging should be considered in children with growth hormone deficiency, particularly when accompanied by other pituitary hormone abnormalities. Early recognition and coordinated multidisciplinary management are essential to optimize oncologic outcomes and long-term quality of life.