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CASE REPORT
Unusual cause of profound weight loss in a young woman
  1. Ashu Rastogi1,
  2. Pavan Uppula1,
  3. Kanchan Kumar Mukherjee2,
  4. Anil Bhansali1,3
  1. 1Department of Endocrinology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
  2. 2Department of Neurosurgery, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, Chandigarh UT, India
  3. 3Post Graduate Institute of Medical Education and Research, Chandigarh, India
  1. Correspondence to Dr Anil Bhansali, anilbhansaliendocrine{at}gmail.com

Summary

A 27-year-old woman presented with anorexia, weight loss and psychiatric symptoms for the past 4 years. She did not have history of headache, visual disturbances or symptoms of raised intracranial pressure. She was sarcopenic with body mass index of 10.16 kg/m2.Her systemic examination was normal except for temporal hemianopia suggesting a sellar/suprasellar lesion. Hormonal evaluation revealed pan-hypopituitarism with central diabetes insipidus. Subsequent neuroimaging revealed sellar-suprasellar mass lesion with intense contrast enhancement and leptomeningeal metastases. Cerebrospinal fluid analysis showed elevated β human chorionic gonadotropin and the presence of syncytiotrophoblast germ cells. Histopathology from the mass lesion confirmed the diagnosis of germinoma. Immunohistochemistry of the tumour tissue was positive for c-kit and placental alkaline phosphatise. She received a combination of chemotherapy with craniospinal irradiation. Significant weight loss in a young woman may not always be an eating disorder like anorexia nervosa albeit more common than germ cell tumour.

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Footnotes

  • Contributors AR was involved in patient care, writing and editing of the manuscript. PU was involved in patient care, and writing of the manuscript. KKM did the biopsy of the tumour tissue. AB was involved in patient care and editing of the manuscript.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.