Abstract
We present an unusual case of primary central nervous system (CNS) lymphoma presenting with bilateral symmetric hypothalamic lesions causing diabetes insipidus and hypopituitarism. A 50-year-old male presented initially with mental status changes, polyuria and polydipsia. The patient was determined to have diabetes insipidus (DI) and significant anterior pituitary deficiencies resulting in symptomatic pleural and pericardial effusions. Brain MRI with contrast demonstrated bilateral enhancement of his hypothalamus extending to the optic tract. The extensive diagnostic workup that ensued on his initial presentation was non-diagnostic as he had no obvious site of involvement that was easily accessible to biopsy. With close follow-up, the patient had rapid radiographic progression of his disease to his cerebral hemispheres. He therefore underwent brain biopsy and was diagnosed with primary CNS large B cell lymphoma. Chemotherapy has resulted in disease remission with resolution of MRI findings, but the patient has not had resolution of the hypopituitarism or DI. This case highlights the unique diagnostic challenge of patients with isolated hypothalamic lesions.
References
Sam S, Molitch ME (2005) The pituitary mass: diagnosis and management. Rev Endocr Metab Disord 6:55–62. doi:10.1007/s11154-005-5225-z
Freda PU (2002) Tuberculosis of the pituitary and sellar region. Pituitary 5:147–148. doi:10.1023/A:1023363429570
Petrossians P, Delvenne P, Flandroy P et al (1998) An unusual pituitary pathology. J Clin Endocrinol Metab 83:3454–3458. doi:10.1210/jc.83.10.3454
Hochberg FH, Baehring JM, Hochberg EP (2007) Primary CNS lymphoma. Nat Clin Pract Neurol 3:24–35. doi:10.1038/ncpneuro0395
Quintero Wolfe S, Hood B, Barker J et al (2008) Primary central nervous system lymphoma mimicking pituitary apoplexy: case report. Pituitary. doi:10.1007/s11102-008-0084-8
Capra M, Wherrett D, Weitzman S et al (2004) Pituitary stalk thickening and primary central nervous system lymphoma. J Neurooncol 67:227–231. doi:10.1023/B:NEON.0000021863.06620.48
Ikeda T, Hara K, Yamanaka T et al (2006) A case of primary central nervous system malignant lymphoma developing from the optic chiasma and hypothalamus. Rinsho Shinkeigaku 46:475–489
Katz BJ, Jones RE, Digre KB et al (2003) Panhypopituitarism as an initial manifestation of primary central nervous system non-Hodgkin’s lymphoma. Endocr Pract 9:296–300
Case records of the Massachusetts General Hospital (1994) Weekly clinicopathological exercises. Case 36-1994. A 49-year-old man with hypopituitarism, multifocal neurologic defects, and an intracranial mass. N Engl J Med 331:861–868. doi:10.1056/NEJM199409293311308
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Layden, B.T., Dubner, S., Toft, D.J. et al. Primary CNS lymphoma with bilateral symmetric hypothalamic lesions presenting with panhypopituitarism and diabetes insipidus. Pituitary 14, 194–197 (2011). https://doi.org/10.1007/s11102-008-0166-7
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11102-008-0166-7