Figure 3.

(a) A 10-year-old male presented with significant facial and pubic hair growth, deepening voice, and minimal testicular enlargement (5 mL bilaterally). Laboratory evaluation showed a markedly elevated β-hCG, pubertal testosterone, and suppressed gonadotropin levels, consistent with hCG-mediated sexual precocity. (b) MRI revealed a large pineal mass (star). Note the effects of tumor-induced hydrocephalus on the hypothalamic-pituitary unit (arrows). Pathology revealed a mixed germ cell tumor and the patient had a complete response to therapy. He entered endogenous puberty normally and has a final height of 68 inches (midparental height 71 inches).