The suggested causes were se condary metabolic and hormonal changes, such as hypercholesterolemia, hypertriglyceridemia, obesity and high levels of follicle stimulating hormone (FSH) and luteinizing hormone (LH).22 In a single institutional experience, the incidence of major thromboembolic complications in a group of 179 patients receiving first-line chemotherapy for GCT was as high as 8.4%. The gene discussed is PLOD1; the disease is familial hypercholesterolemia.