Pituitary infiltration by non-Hodgkin's lymphoma: a case report

Tamer, Gonca; Kartal, Ilkay; Aral, Feríhan

doi:10.1186/1752-1947-3-9293

Cited by 22 publications

(19 citation statements)

References 8 publications

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“…Although the low gonadotrophin levels in the last patient were deemed to be due to direct infiltration of the anterior pituitary by the author, this may, however, could also be the result of suppression by hyperprolactinaemia (5). Four of those nine patients with anterior pituitary dysfunction also had concurrent posterior pituitary dysfunction manifested as diabetes insipidus while two other patients presented with isolated diabetes insipidus.…”

Section: Discussionmentioning

confidence: 88%

Burkitt's lymphoma presenting with hypopituitarism: a case report and review of literature

Foo¹,

Sobah

2014

Endocrinology, Diabetes &Amp; Metabolism Case Reports

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SummaryHypopituitarism is a rare presentation of Burkitt's lymphoma (BL). The purpose of this report is to present a case of BL presenting with panhypopituitarism and to review other case reports of lymphoma presenting with pituitary dysfunction to highlight the distinguishing features of these cases from other benign aetiologies of pituitary dysfunction such as non-functioning pituitary adenomas. We reviewed a total of 11 cases of lymphoma presenting with pituitary dysfunction published from 1998 to 2013 including the present case. The demographics, clinical presentations, laboratory features, radiological findings, histological diagnosis, treatment administered and outcomes were described. Of the total number of patients, 45.5% of the cases had diffuse large B-cell lymphoma while 27.3% had BL. Anterior pituitary dysfunction was more common than posterior pituitary dysfunction at presentation. The other common associated presenting symptoms were painful ophthalmoplegia, cranial nerve palsies and constitutional symptoms. Hypothalamic–pituitary abnormalities were often demonstrated radiologically to be associated with cavernous sinus and/or stalk involvement. All patients who completed immunochemotherapy responded haematologically. Pituitary dysfunction also improved in most cases although the recovery tended to be partial. In conclusion, a high index of suspicion of underlying malignancy, such as lymphoma, should be present in patients presenting with acute pituitary dysfunction associated with painful ophthalmoplegia, rapidly evolving neurological features, radiological features atypical of a pituitary adenoma and constitutional symptoms. An early diagnosis is essential as prompt initiation of definitive therapy will induce disease remission and recovery of pituitary dysfunction.Learning points Hypopituitarism may be the presenting symptom of lymphoma in the absence of associated overt symptoms or signs of a haematological malignancy resulting in delay in diagnosis and institution of treatment.Pituitary dysfunction due to tumour infiltration has a greater tendency to involve the posterior pituitary and infundibulum resulting in diabetes insipidus and hyperprolactinaemia compared with a non-functioning pituitary adenoma.The common associated symptoms of hypopituitarism due to lymphoma infiltration of the hypothalamic–pituitary system include painful ophthalmoplegia, cranial nerve palsies and constitutional symptoms.Radiological abnormalities of the hypothalamic–pituitary region are usually present and often associated with cavernous sinus or stalk involvement.With early institution of definitive treatment, both haematological response and improvement of pituitary dysfunction are expected although the reversal of hypopituitarism tends to be partial and delayed.A high index of suspicion of underlying malignancy such as lymphoma should be present in patients presenting with acute pituitary dysfunction associated with painful ophthalmoplegia, radiological features atypical of pituitary adenomas and constitutional sym...

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Section: Discussionmentioning

confidence: 88%

Burkitt's lymphoma presenting with hypopituitarism: a case report and review of literature

Foo¹,

Sobah

2014

Endocrinology, Diabetes &Amp; Metabolism Case Reports

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“…Infiltration of lymphoma cells to the pituitary gland lead to headache, opthalmoplegia, or hemianopia [6], and often causes diabetes insipidus [6]. Anasarca is a rare symptom in patients with lymphoma [1].…”

Section: Discussionmentioning

confidence: 99%

A rare case of anasarca caused by infiltration of the pituitary gland by diffuse large B-cell lymphoma

et al. 2015

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BackgroundAnasarca in patients with lymphoma is a rare symptom. We report a patient with DLBCL associated with pituitary gland infiltration that was diagnosed based on significant anasarca.Case presentationA 72-year-old woman with a 10-year history of hypertension visited a local hospital presenting with anasarca and 15-kg weight gain in the past 3 months. we clinically diagnosed central hypothyroidism caused by pituitary gland infiltration of diffuse large B-cell lymphoma (DLBCL) (clinical stage IV in the Ann Arbor staging classification). The first course of chemotherapy improved anasarca remarkably and the patient’s body weight returned to what it was 3 months before.ConclusionsWe experienced a patient with remarkable anasarca caused by DLBCL infiltration of the pituitary gland. A pituitary gland lesion with central hypothyroidism should be considered as one of the differential diagnoses of edema. This case was very valuable because we could assess it by following the time course of symptoms (edema and delayed relaxation time of the Achilles tendon reflex), laboratory data, and imaging findings (swelling anterior pituitary lobe).

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“…Mechanisms of the latter include hematogenous or meningeal spread and direct extension from the juxtasellar and skull base lesions, as seen in our case. A vast majority of the cases are asymptomatic due to the great reserve capacity of the pituitary gland (1,2). When symptomatic, posterior pituitary deficiencies are more common than anterior (2).…”

Section: Discussionmentioning

confidence: 99%

“…When symptomatic, posterior pituitary deficiencies are more common than anterior, as the posterior pituitary is supplied directly by the systemic circulation. Therefore, diabetes insipidus (DI) seems to be the most frequent symptom of pituitary metastasis, although B-cell lymphoma itself represents a rare cause of DI (1).…”

Section: Introductionmentioning

confidence: 99%

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Diffuse Large B-Cell Lymphoma Presenting with Diabetes Insipidus: A Case Report

Kaur

Thomas

2015

AACE Clinical Case Reports

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Objective:To present a rare case of pituitary gland involvement in paranasal and central nervous system (CNS) lymphoma.Methods: We describe the clinical presentation, laboratory data at presentation and follow-up, imaging studies, and management of the patient. A brief review of literature regarding pituitary involvement in lymphoma is also presented.Results: A 53-year-old woman with a history of human immunodeficiency virus (HIV) infection was evaluated for 6-month history of polydipsia, high-volume polyuria, and headache. Laboratory work-up was consistent with diabetes insipidus. Magnetic resonance imaging showed a 6-mm lesion in the posterior pituitary and ill-defined decreased T1 signal in the clivus and sphenoid sinus. She was treated medically with desmopressin for her urinary symptoms, with symptomatic improvement. In the interim, she was admitted for acute visual loss. Repeat imaging revealed a soft tissue mass involving paranasal sinuses with intracranial extension to the sella and hypothalamus. Biopsy confirmed the diagnosis of diffuse large B-cell lymphoma. The patient was treated urgently with multidrug chemotherapy and intraventricular methotrexate, resulting in neurologic improvement. After 12 cycles, the patient did well, with regression of the tumor and marked improvement of her urinary symptoms with decreasing desmopressin requirement.Conclusion: This is a rare case of hypothalamuspituitary involvement in a diffuse, large B-cell lymphoma due to paranasal sinus involvement with CNS extension, presenting with central diabetes insipidus. Early detection with a high index of suspicion (particularly in patients with HIV) and treatment can lead to better outcomes. (AACE Clinical Case Rep. 2015;1:e111-e114) Abbreviations: AIDS = acquired immune deficiency syndrome; CNS = central nervous system; DI = diabetes insipidus; HAART = highly active antiretroviral treatment; HIV = human immunodeficiency virus; MRI = magnetic resonance imaging

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Pituitary infiltration by non-Hodgkin's lymphoma: a case report

Cited by 22 publications

References 8 publications

Burkitt's lymphoma presenting with hypopituitarism: a case report and review of literature

Burkitt's lymphoma presenting with hypopituitarism: a case report and review of literature

A rare case of anasarca caused by infiltration of the pituitary gland by diffuse large B-cell lymphoma

Diffuse Large B-Cell Lymphoma Presenting with Diabetes Insipidus: A Case Report

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