Hodgkin's Disease Involving the Pituitary Gland With Diabetes Insipidus

Melton, Ernest I.; McNamara, W. L.

doi:10.7326/0003-4819-25-3-525

Cited by 6 publications

(2 citation statements)

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“…Bunick et al described a case of nasopharyngeal CHL eroding into the sella turcica and causing anterior pituitary insufficiency ( 7 ). In 1946, a case of Hodgkin lymphoma (type not specified) presenting with lymphadenopathy who later manifested diabetes insipidus was reported; autopsy confirmed pituitary involvement ( 8 ). The discussion listed four other cases (published in non-English journals) of ‘lymphogranuloma’ presenting with lymphadenopathy, three of whom developed diabetes insipidus and had pituitary involvement confirmed at autopsy and one of whom only had post-mortem evidence of pituitary involvement ( 8 ).…”

Section: Discussionmentioning

confidence: 99%

“…In 1946, a case of Hodgkin lymphoma (type not specified) presenting with lymphadenopathy who later manifested diabetes insipidus was reported; autopsy confirmed pituitary involvement ( 8 ). The discussion listed four other cases (published in non-English journals) of ‘lymphogranuloma’ presenting with lymphadenopathy, three of whom developed diabetes insipidus and had pituitary involvement confirmed at autopsy and one of whom only had post-mortem evidence of pituitary involvement ( 8 ). Other cases of pituitary gland involvement by Hodgkin lymphoma unsuspected pre-mortem but identified at autopsy have been reported but only extremely rarely.…”

Section: Discussionmentioning

confidence: 99%

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A woman with visual loss, amenorrhoea and polyuria: the first reported case of nodular lymphocyte-predominant Hodgkin lymphoma presenting with hypopituitarism

Seymour

Robertson

Papacostas

et al. 2021

Endocrinology, Diabetes &Amp; Metabolism Case Reports

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Summary A 34-year-old woman presented 18 months post-partum with blurred vision, polyuria, amenorrhoea, headache and general malaise. Comprehensive clinical examination showed left superior temporal visual loss only. Initial investigations revealed panhypopituitarism and MRI demonstrated a sellar mass involving the infundibulum and hypothalamus. Lymphocytic hypophysitis was suspected and high dose glucocorticoids were commenced along with desmopressin and thyroxine. However, her vision rapidly deteriorated. At surgical biopsy, an irresectable grey amorphous mass involving the optic chiasm was identified. Histopathology was initially reported as granulomatous hypophysitis. Despite the ongoing treatment with glucocorticoids, her vision worsened to light detection only. Histopathological review revised the diagnosis to partially treated lymphoma. A PET scan demonstrated avid uptake in the pituitary gland in addition to splenic involvement, lymphadenopathy above and below the diaphragm, and a bone lesion. Excisional node biopsy of an impalpable infraclavicular lymph node confirmed nodular lymphocyte-predominant Hodgkin lymphoma. Hyper-CVAD chemotherapy was commenced, along with rituximab; fluid-balance management during chemotherapy (with its requisite large fluid volumes) was extremely complex given her diabetes insipidus. The patient is now in clinical remission. Panhypopituitarism persists; however, her vision has recovered sufficiently for reading large print and driving. To the best of our knowledge, this is the first reported case of Hodgkin lymphoma presenting initially as hypopituitarism. Learning points Lymphoma involving the pituitary is exceedingly rare and, to the best of our knowledge, this is the first reported case of nodular lymphocyte-predominant Hodgkin lymphoma presenting as hypopituitarism. There are myriad causes of a sellar mass and this case highlights the importance of reconsidering the diagnosis when patients fail to respond as expected to appropriate therapeutic intervention. This case highlights the difficulties associated with managing panhypopituitary patients receiving chemotherapy, particularly when this involves large volumes of i.v. hydration fluid.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%