Diabetes insipidus with impaired vision caused by germinoma and perioptic meningeal seeding: A case report

Table 1 Seven cases of germinoma presenting with central diabetes insipidus and visual loss reported in the literature

Ref.	Age/gender	Duration of CDI	Duration of visual acuity decline	Other clinical presentation	Abnormal hormones	Cranial MRI	Tumor markers (serum)	Tumor markers (CSF)	Funduscopic examination	Treatment	Prognosis
Pal et al[6]	12/F	6 yr	3 yr	Headache, vomiting	Low free T4, low cortisol, low ACTH	Suprasellar mass with infundibular stalk thickening, pineal mass	Normal	Normal	Bilateral disk pallor	Chemotherapy	Died of sepsis
Huang et al[9]	21/M	3 yr	3 mo	-	-	Suprasellar mass, enhancement of the ventricular surface, bilateral optic nerve and optic chiasm	-	-	Optic disc pallor, a cup to disc ratio (C/D) of 0.4	Radiotherapy and chemotherapy	Visual acuity of his right eye improved, but left did not
Huang et al[9]	24/M	2 yr	1.5 yr	Hypogonadism, visual field defects	-	Suprasellar and pineal region mass	Normal	β-HCG elevated	Optic disc pallor	Radiotherapy	Visual acuity in both eyes improved
Huang et al[9]	13/F	3.5 yr	1.5 yr	Nausea, vomiting, fever	-	Suprasellar mass	-	-	Optic disc pallor	Craniotomy for tumor resection	Visual acuity in both eyes was worse
Nakajima et al[4]	31/M	/	2 yr	Motor weakness, panhypopituitarism	-	Left basal ganglia bilateral mass and the optic nerves enhanced	Normal	Normal	Bilateral optic atrophy	Chemotherapy and Radiotherapy	Visual acuity improved
Nakajima et al[4]	27/M	5 yr	8 mo	General fatigue, double vision	-	Pituitary stalk, pineal region, corpus callosum, thalamus and basal ganglia mass, lateral ventricle, optic nerve and the inferior part of the left dentate nucleus enhanced	β-HCG elevated	-	bilateral atrophy of the optic nerves	Chemotherapy and radiotherapy	Visual acuity improved
Pereira et al[10]	34/F	12 yr	3 mo	Hypopituitarism, facial paralysis	-	Pituitary stalk mass, optic nerves enhanced	AFP and β-HCG elevated	Normal	Relative afferent pupillary defect and optic disc pallor	Chemotherapy and radiotherapy	Visual acuity improved

CDI: Central diabetes insipidus; MRI: Magnetic resonance imaging; CSF: Cerebrospinal fluid; ACTH: Adrenocorticotropic hormone; β-HCG: Beta human chorionic gonadotropin; AFP: Alpha-fetoprotein.