Paediatric sellar mature teratoma with isolated growth hormone deficiency - A case-based review

Intracranial germ cell tumours (IGCTs) are rare, accounting for only 0.5-3% of central nervous system tumours in children, with teratomas representing a minority. Sellar teratomas are exceptionally rare, with fewer than 50 reported cases, often mimicking craniopharyngioma on imaging.

We report a case of a 7-year-old boy with isolated growth hormone deficiency and no visual or neurological deficit. MRI showed a heterogeneous sellar-suprasellar mass, while CT demonstrated multiple ossified components within the lesion. PubMed was searched through July 2026 for reports of paediatric sellar teratomas, and the reference lists of retrieved articles were screened for additional cases.

Endoscopic transnasal transsphenoidal surgery achieved gross total resection of the lesion, including 11 fully formed teeth embedded in keratinised tissue; histology confirmed a mature teratoma. Recovery was uneventful, and the child remains recurrence-free at 1-year follow-up while receiving hormone replacement therapy. Seven paediatric mature sellar teratomas, including the present case, were reviewed. Visual symptoms and endocrine dysfunction were common presentations, whereas isolated growth hormone deficiency was unusual.

Preoperative identification of teeth or fat on CT should raise suspicion of teratoma over other sellar lesions, while high-resolution imaging may assist surgical planning. For mature teratomas, complete resection may provide disease control, while chemotherapy and radiotherapy have limited role. In our case, the endoscopic transnasal transsphenoidal approach allowed gross total resection despite poor sphenoid pneumatization. Continued follow-up is appropriate to monitor persistent endocrine dysfunction and detect rare metachronous germ cell tumours.