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

Abstract

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.

Primary central nervous system diffuse large B-cell lymphoma in fourth ventricle: Case report and literature review

“…[ 10 ] Because there is no significant difference in the postoperative survival rate of patients with total resection compared people with biopsy. [ 11 , 12 ] And someone believes that total tumor resection may cause brain damage and neurological impairment. [ 13 ] We searched for the previous reports on fourth ventricle lymphoma in Pubmed and summarized the results into a table (Table 2 ).…”

Central Diabetes Insipidus in a Patient With Lymphoma: A Case Report

“…Among the cancers that infiltrate the pituitary, lymphomas represent only 0.5% [ 11 ]. Primary CNS lymphoma and secondary infiltrative lymphoma can infiltrate the hypothalamus and induce CDI with panhypopituitarism [ 9 , 12 ]. Moreover, lymphoma can infiltrate the pituitary stalk, depicted as thickening in imaging studies and causing hypopituitarism along with CDI [ 13 ].…”

“…Our patient had pulmonary lesions, while tuberculosis had been excluded as the cause. Angiotensin-converting enzyme (ACE) levels, as well as serum and urine calcium, were within normal limits; however, CDI due to sarcoidosis and neurosarcoidosis could not be excluded [9,10] (Figure 2). Primary or secondary CNS tumors can infiltrate the hypothalamus or pituitary gland and cause CDI.…”

Somatostatin and Somatostatin Receptors in Tumour Biology

“…SSTR scintigraphy is frequently used to visualize the tumors positive to SST but not PCNSL [ 173 ]. Brain regions affected with PCNSL include basal ganglia, thalamus, periventricular white matter [ 174 , 175 ]. It is also interesting to note that brain regions, despite of good expression of SST and SSTR subtypes, exhibit no association with PCNSL pathogenesis.…”