Clinical presentation
The presenting symptoms included those attributable to RICP (24/55; 43.6%), endocrine disturbances (17/55; 30.9%), visual impairment (5/55; 9.1%) and other symptoms such as neurological signs, behavioural changes, and fatigue (9/55; 16.4%). Retrospectively, two patients exhibiting headache and visual disturbance reported previous history of uninvestigated endocrine manifestations (precocious puberty and polyuria/polydipsia). Among those patients who displayed endocrinopathy as first symptom, the majority (12/17; 70.6%) had diabetes insipidus, 4 patients (23.5%) with poor growth, and 1 boy (5.9%) with precocious puberty. By the time of tumour diagnosis, however, over half of the patients had developed hydrocephalus (29/55; 52.7%) or endocrine dysfunctions (28/55; 50.9%).
The symptom profile differed by tumour location: pineal GCTs manifested with symptoms of hydrocephalus (19/20) or visual defects (1/20), whereas all suprasellar GCTs initially caused symptoms related to endocrinopathies. Among the 7 bifocal tumours, 3 patients presented with RICP symptoms, 2 with an endocrinopathy (polyuria/polydipsia in both cases), 1 with diplopia and 1 with fatigue for 3 months.