Hypothalamic dysfunction in a patient with primary lymphoma of the central nervous system

Smiljanic, Mihajlo; Bila, Jelena; Jankovic, Snezana; Todorović, Milena; Andjelic, Bosko; Mihaljević, Biljana

doi:10.1007/s10072-011-0726-x

Cited by 10 publications

(6 citation statements)

References 12 publications

(13 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Anterior pituitary hormone deficiencies are present in 70-100% of patients with sellar lymphoma, attributed to pituitary gland infiltration by lymphoma cells [8,15,16]. Lymphoma cells may also infiltrate the hypothalamus causing central diabetes insipidus [25]. In large studies, diabetes insipidus developed in 30.8%-36% of patients [15,16].…”

Section: Discussionmentioning

confidence: 99%

The sellar region as presenting theater for hematologic malignancies—A 17-year single-center experience

et al. 2022

Self Cite

View full text Add to dashboard Cite

Hematological neoplastic mass lesions of the sellar region are rare. We identified five cases of hematological malignancy with first presentation in the sellar region from our departmental database of 1,405 patients (0.36%) with sellar lesions diagnosed over the 17-year period (2005-2021). All patients were females (mean age 55.2 ± 3.4 years). One patient had multiple myeloma (MM), one patient had acute myeloid leukemia (AML), while three other patients had lymphoma (intravascular lymphoma (IVL, n = 1) or non-Hodgkin's lymphoma (NHL, n = 2). Most patients presented with ophthalmoplegia, and one patient with diabetes insipidus (DI), with short duration of symptoms (median 30 days). All patients had an elevated erythrocyte sedimentation rate and altered blood count, while patients with lymphoma had elevated lactate dehydrogenase (LDH). Sellar mass was demonstrated in three patients while the patient with IVL had an empty sella and in the AML patient posterior lobe T1W hyperintensity was lost. Two patients (IVL and NHL) presented with multiple anterior pituitary deficiencies and one patient (AML) had DI. All patients were treated with chemotherapy. Two patients responded well to treatment (one had reversed hypopituitarism), while three patients died. Differential diagnosis of sellar-parasellar pathology should include suspicion of hematological malignancy, particularly in patients with short duration of nonspecific symptoms, neurological signs (ophthalmoplegia), blood count alterations and LDH elevation, pituitary dysfunction and imaging features atypical for pituitary adenoma. Early diagnosis is crucial for timely initiation of hematological treatment aimed at inducing disease remission and partial or full recovery of pituitary function.

show abstract

Section: Discussionmentioning

confidence: 99%

The sellar region as presenting theater for hematologic malignancies—A 17-year single-center experience

et al. 2022

Self Cite

View full text Add to dashboard Cite

show abstract

“…The occurrence of hypothalamic lesions with findings mimicking pituitary apoplexy is an extremely rare condition [ 18 ]. The most common symptoms and findings of hypothalamic lesions are DI, hypernatremia, hyper- or hypothermia, and eating, sleep and behavioral disorders [ 19 ]. Our patient initially presented with altered circadian sleep rhythms and then subsequently with polydipsia, polyuria, extremely diluted urine and elevated serum sodium indicating DI.…”

Section: Discussionmentioning

confidence: 99%

Primary hypothalamic lymphoma with clinical findings mimicking pituitary apoplexy: a case report

et al. 2021

View full text Add to dashboard Cite

Background Primary central nervous system lymphoma (PCNSL) is a rare but well-known extra-nodal lymphoma, which usually presents with non-Hodgkin B-cell lymphomas. PCNSL is generally located around the ventricle and is often detected as multiple lesions. It is rarely seen in the area of the hypothalamus. Case presentation We report the case of a 48-year-old Caucasian woman with progressive short-term memory deterioration, headache, mental confusion, diabetes insipidus (DI) and hypopituitarism. Early findings were suggestive of a pituitary apoplexy. The results of tests performed during the initial admission at the tertiary health center revealed hypernatremia, hypopituitarism and DI. Intravenous hydrocortisone treatment was initiated for the secondary adrenal insufficiency, and 75 mcg/day of levothyroxine was started for the secondary hypothyroidism on the fourth day following hydrocortisone treatment. A daily dose of 120 mg desmopressin melt tablet was started twice a day for polyuria/polydipsia after the patient’s volume status was balanced. A brain magnetic resonance imaging scan revealed a mass lesion in the hypothalamic area, which was surrounded by marked edema. Anti-edema treatment was initially started considering the suggestion by our neurosurgery team. The patient’s clinical and laboratory findings improved after the initiation of the anti-edema therapy. Afterwards, a biopsy was performed, which diagnosed a malignant diffuse large B-cell lymphoma. Subsequently, intravenous high-dose methotrexate-based therapy was started; however, after the second cycle of chemotherapy, the patient died due to sepsis. Conclusion In this report, we present a case of hypopituitarism that developed due to the mass effect of hypothalamic lymphoma with clinical findings of pituitary apoplexy. Intracranial masses may cause obvious endocrinological findings related to hypopituitarism, while vague findings may also be observed due to partial failure. Therefore, it is important to perform a comprehensive endocrinological examination at the time of diagnosis in patients with intracranial masses.

show abstract

“…The hypothalamus is the body's master regulator and is responsible for blood pressure, fluid/electrolyte, body weight, and temperature homeostasis (6). Hypothalamic disorders can result in either polyphagia/obesity or anorexia/cachexia (secondary to disturbances of appetite), disrupted circadian sleep rhythms, behavioral disorders, temperature dysregulation, and autonomic dysregulation (7,8).…”

Section: Discussionmentioning

confidence: 99%

Hypothalamic Germinoma Masquerading as Superior Mesenteric Artery (Sma) Syndrome

et al. 2013

View full text Add to dashboard Cite

Hypothalamic dysfunction in a patient with primary lymphoma of the central nervous system

Cited by 10 publications

References 12 publications

The sellar region as presenting theater for hematologic malignancies—A 17-year single-center experience

The sellar region as presenting theater for hematologic malignancies—A 17-year single-center experience

Primary hypothalamic lymphoma with clinical findings mimicking pituitary apoplexy: a case report

Hypothalamic Germinoma Masquerading as Superior Mesenteric Artery (Sma) Syndrome

Contact Info

Product

Resources

About