Diffuse large B-cell non Hodgkin's lymphoma in a 65-year-old woman presenting with hypopituitarism and recovering after chemotherapy: a case report

Manohara Kenchaiah,Steve L Hyer

doi:10.1186/1752-1947-5-498

Abstract

IntroductionDiffuse large B-cell non Hodgkin's lymphoma may involve the pituitary either as a primary central nervous system lymphoma or, more frequently, as metastasis from systemic lymphoma leading to hypopituitarism. A partial recovery of pituitary function after treatment with chemotherapy has previously been described but complete recovery with cessation of all hormone supplements is excessively rare. We report a patient presenting with anterior hypopituitarism with subsequent complete and sustained recovery of pituitary function after successful treatment of the lymphoma.Case presentationA 65-year-old Caucasian woman with lethargy, loss of appetite and peripheral edema was found to have anterior hypopituitarism. Magnetic resonance imaging showed no mass lesions in the pituitary although a positron emission tomography scan showed abnormal pituitary activity. An abdominal computed tomography scan revealed multiple intra-abdominal lymph nodes, which on histology proved diagnostic of diffuse large B-cell non Hodgkin's lymphoma. She received six cycles of R-CHOP chemotherapy, after which she achieved a complete metabolic response at all known previous sites of the disease, confirmed by positron emission tomography scanning. Concomitant with the tumor response, there was full recovery of adrenal, thyroid and gonadal axes which has persisted at 10 months follow-up.ConclusionAlthough rare, it is important to recognize lymphomatous infiltration of the pituitary as a potentially reversible cause of hypopituitarism.

Highlights

Diffuse large B-cell non Hodgkin’s lymphoma may involve the pituitary either as a primary central nervous system lymphoma or, more frequently, as metastasis from systemic lymphoma leading to hypopituitarism
We describe a patient with diffuse large B-cell lymphoma metastasizing to the anterior pituitary, in whom pituitary function was restored after successful treatment of the lymphoma
Partial recovery of anterior hypopituitarism was reported after successful chemotherapy but the patient continued to require thyroxine [4]

Summary

Introduction

Pituitary involvement of lymphoma either at presentation or late in the disease is rare. Case presentation A 65-year-old Caucasian woman presented with a sixweek history of lethargy and loss of appetite She had noticed progressive pedal edema for a few weeks. Baseline plasma adrenocorticotropic hormone was reduced at 4 ng/L (reference range 10 ng/L to 40 ng/L) in keeping with secondary hypoadrenalism She was started on hydrocortisone replacement and showed slight improvement. There was no evidence of diabetes insipidus These tests were interpreted as showing generalized anterior pituitary dysfunction. Magnetic resonance imaging (MRI) of her pituitary (Figure 1) revealed no mass lesions in her pituitary In view of her peripheral edema, an abdominal and pelvic ultrasound was performed which revealed multiple intra-abdominal lymph nodes, multiple solid liver lesions and a 2 cm right groin lymph node (Figure 2). Full body computed tomography (CT) confirmed the ultrasound findings as well as identifying involvement of the base of her skull She underwent a biopsy from a right groin. There was full recovery of her adrenal, thyroid and gonadal axes and she was off all medication and clinically well when reviewed in the endocrine clinic 10 months after completing chemotherapy (see Table 1)

Discussion

Conclusion