Outcome measures and definitions
The key outcome measures regarding diagnostic intervals were calculated for each patient (Fig. 1) . Total diagnostic interval (TDI) was defined as the interval between date of the first reported symptom onset (including retrospective recall of symptoms) and diagnosis. Patient-related interval (PI) was defined as the interval between symptom onset and initial referral to a healthcare specialist; healthcare-related interval (HI) was defined as the interval between specialist evaluation and first brain MRI; tumour-related interval (TI) was defined as the interval between first brain MRI and definitive diagnosis of IC-GCT. Time lag to diagnosis from the first symptom longer than 6 months (TDI >6 months) was identified in all patients, to allow direct comparison of our results with previous studies15,17,21,23, whereas PI, HI and TI were investigated only when an endocrine disorder was the presenting symptom. Subgroup analyses by age at diagnosis, tumour grade and tumour location were also performed.
We recorded oncologic treatments (chemotherapy, surgery, radiotherapy), tumour recurrence and death.