case_images: PMC9445167_01
case_images: Gadolinium-enhanced brain magnetic resonance highlighting a 5 mm bilobed cyst of the pineal gland (arrow).
case_images: fped-10-940656-g001.jpg
case_images: PMC9445167_01_fped-10-940656-g001.jpg
case_images: F1
case_images: However, marginally raised serum beta-hCG of 15 IU/L (reference range: 0-10 IU/L, limit of detection of the assay: 0.2 IU/L) prompted the indication of a complete oncological work-up, in order to rule out a secreting germ cell tumor: chest CT scan, testicular ultrasound, abdomen and head/spine MRI and ophthalmological evaluation were unremarkable, except for the previously known pineal bilobed cystic lesion (Figure 1).
case_images: Patient's growth chart according to the CDC height centiles for reference population. Red dots represent the height recorded at each time point. Green triangles represent patient's bone age. The red arrow indicates familiar height target.
case_images: fped-10-940656-g002.jpg
case_images: PMC9445167_02_fped-10-940656-g002.jpg
case_images: F2
case_images: He is still on GnRH analog and recombinant human GH treatment and he is showing regular height velocity (Figure 2).
case_images: Serum/cerebrospinal beta-hCG, serum alpha-fetoprotein, and serum testosterone levels recorded at different time points in relation to the treatments undertaken in the patient described.
case_images: fped-10-940656-g003.jpg
case_images: PMC9445167_02_fped-10-940656-g003.jpg
case_images: F3
case_images: AFP and beta-hCG normalized during treatment (Figure 3), as well as the AFP and beta-hCG in CSF, prompting the discontinuation of bicalutamide and anastrozole when the patient was 7.8 years old. At this age, his Tanner stage was genitalia 4, pubic hair 4 and axillary hair 2, with testicular volume of 6 mL bilaterally.
case_images: PMC9445167_02
case_images: Patient's growth chart according to the CDC height centiles for reference population. Red dots represent the height recorded at each time point. Green triangles represent patient's bone age. The red arrow indicates familiar height target.
case_images: fped-10-940656-g002.jpg
case_images: PMC9445167_02_fped-10-940656-g002.jpg
case_images: F2
case_images: He is still on GnRH analog and recombinant human GH treatment and he is showing regular height velocity (Figure 2).
case_images: Serum/cerebrospinal beta-hCG, serum alpha-fetoprotein, and serum testosterone levels recorded at different time points in relation to the treatments undertaken in the patient described.
case_images: fped-10-940656-g003.jpg
case_images: PMC9445167_02_fped-10-940656-g003.jpg
case_images: F3
case_images: AFP and beta-hCG normalized during treatment (Figure 3), as well as the AFP and beta-hCG in CSF, prompting the discontinuation of bicalutamide and anastrozole when the patient was 7.8 years old. At this age, his Tanner stage was genitalia 4, pubic hair 4 and axillary hair 2, with testicular volume of 6 mL bilaterally.
case_images: Timeline that summarizes the events reported. MRI, magnetic resonance imaging; GIPP, GnRH independent precocious puberty; GCT, germ cell tumor; CPP, central precocious puberty.
case_images: fped-10-940656-g004.jpg
case_images: PMC9445167_02_fped-10-940656-g004.jpg
case_images: F4