Yang N, Zhu HJ, Yao Y, He LY, Li YX, You H, Zhang HB. Diabetes insipidus with impaired vision caused by germinoma and perioptic meningeal seeding: A case report. World J Clin Cases 2021; 9(8): 1976-1982 [PMID: 33748249 DOI: 10.12998/wjcc.v9.i8.1976]
Corresponding Author of This Article
Hua-Bing Zhang, MD, Associate Professor, Department of Endocrinology, Key Laboratory of Endocrinology of National Health Commission, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 1 Shuaifuyuan, Wangfujing, Dongcheng District, Beijing 100730, China. huabingzhangchn@163.com
Research Domain of This Article
Endocrinology & Metabolism
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA
Share the Article
Yang N, Zhu HJ, Yao Y, He LY, Li YX, You H, Zhang HB. Diabetes insipidus with impaired vision caused by germinoma and perioptic meningeal seeding: A case report. World J Clin Cases 2021; 9(8): 1976-1982 [PMID: 33748249 DOI: 10.12998/wjcc.v9.i8.1976]
Na Yang, Hui-Juan Zhu, Li-Yun He, Yu-Xiu Li, Hua-Bing Zhang, Department of Endocrinology, Key Laboratory of Endocrinology of National Health Commission, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
Yong Yao, Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
Hui You, Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
Author contributions: Zhang HB, Zhu HJ, Yao Y, and Yang N treated the patient; Zhang HB and Yang N collected the data and drafted the manuscript; Yang N and He LY participated in the analysis; Zhang HB, Zhu HJ, Yao Y, You H, and Li YX critically revised the manuscript; all authors have approved the final article.
Supported byNon-profit Central Research Institute Fund of Chinese Academy of Medical Sciences, No. 2019XK320029; National Natural Science Foundation of China, No. 91846106; and Education and Teaching Reform Project of Peking Union Medical College, No. 2014zlgc0316.
Informed consent statement: Written informed consent was obtained from the patient and her parent for publication of this case report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no competing interests to disclose.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Corresponding author: Hua-Bing Zhang, MD, Associate Professor, Department of Endocrinology, Key Laboratory of Endocrinology of National Health Commission, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 1 Shuaifuyuan, Wangfujing, Dongcheng District, Beijing 100730, China. huabingzhangchn@163.com
Received: November 18, 2020 Peer-review started: November 18, 2020 First decision: December 3, 2020 Revised: December 12, 2020 Accepted: January 8, 2021 Article in press: January 8, 2021 Published online: March 16, 2021 Processing time: 106 Days and 0.2 Hours
Abstract
BACKGROUND
Germinoma is a type of germ cell tumor that most frequently arises in the midline axis of the brain. Impaired vision is a clinical manifestation of germinnoma. Although rare, intracranial germinoma seeding to the perioptic arachnoid space is one cause of visual acuity decrease.
CASE SUMMARY
An 11yearold girl who presented with polyuria and polydipsia and subsequently developed diminution of vision. Imaging showed bilateral heterogeneous enhancement of the optic nerve sheaths and atrophy of the optic nerve, and transsphenoidal biopsy revealed a germinoma. The patient experienced poor visual recovery following chemotherapy and radiotherapy. Germinomas are rare and they are mostly identified in children and adolescents. The manifestations include diabetes insipidus, pituitary dysfunction, visual complaints, etc. The mechanisms that lead to visual loss include intracranial hypertension, compression of optic chiasma, and tumor invasion. A literature review was performed to summarize the cases with a tumor infiltrating the optic nerve. Most of the reported patients were adolescents and presented with anterior pituitary hormone deficiency. Enhancement of optic nerve sheaths and optic disc pallor could be identified in most of the cases. The purpose of this report is to provide awareness that in cases where a germinoma is associated with visual loss, though rare, perioptic meningeal seeding should be taken into consideration.
CONCLUSION
The case report suggests that children with diabetes insipidus need a complete differential diagnosis.
Core Tip: Impaired vision is one of the clinical manifestations of a germinoma, and most of the reduction in visual acuity is caused by compression of the optic chiasma. We present a case of impaired vision caused by a germinoma and perioptic meningeal seeding, which is extremely rare. The findings of this case study emphasize that children with diabetes insipidus need a complete differential diagnosis.
