Hypothalamic germinoma presented with central diabetes mellitus and extreme hypernatremia: A case report

摘要

Hypothalamic germinoma presenting with central diabetes mellitus and extreme hypernatremia is rare. The authors describe a 38-year-old woman with hypothalamic germinoma that manifested as recurrent attacks of nonketotic hyperosmolar hyperglycemia and extreme hypernatremia. Magnetic resonance imaging of the brain showed a hypothalamic tumor and a normal pituitary gland. Examination of endocrine function revealed hypogonadism and hyperprolactinemia. DDAVP test showed central diabetes insipidus. She was treated with tumor debulking and radiotherapy. The glucose level became normal and no more hypoglycemic agent was needed. However, hyperglycemia was noted again 2 months after discharge, with recurrent nonketotic hyperosmolar hyperglycemia and associated hypernatremia. She died at home suddenly 11 months after the diagnosis. Although the survival rate of hypothalamic germinoma is 87.5% over the course of 10 years, symptoms of central diabetes mellitus and extreme hypernatremia may represent a poor prognosis.