IGF1 and Adrenal insufficiency: According to Change et al., who described 49 children with intracranial pure germinoma in Taiwan, growth hormone deficiency or low IGF-1 was diagnosed in 85.7%, adrenal insufficiency in 77.8%, CDI in 55.1%, central hypothyroidism in 48.4%, and hypogonadotropic hypogonadism in 44.4% of children (30).