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.