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A UNIQUE CASE OF CENTRAL HYPOPITUITARISM AND CENTRAL DIABETES INSIPIDUS CAUSED BY DIFFUSE LARGE B-CELL LYMPHOMA

Jason A Stegink, Vishal Sehgal, Manige Konig

    AACE Clinical Case Reports
    |January 23, 2020
    PubMed

    Insights

    A rare case of diffuse large B-cell lymphoma presented with central diabetes insipidus due to pituitary stalk infiltration. This highlights an uncommon cause of endocrine deficiency and malignancy.

    Area of Science:

    • Endocrinology
    • Oncology
    • Pathology

    Background:

    • Diffuse large B-cell lymphoma (DLBCL) is an aggressive non-Hodgkin lymphoma.
    • Pituitary dysfunction can occur secondary to various infiltrative processes.
    • Central diabetes insipidus (CDI) is characterized by inadequate antidiuretic hormone secretion.

    Observation:

    • A 39-year-old male presented with gastrointestinal bleeding and later developed hypernatremia.
    • Diagnosis of DLBCL was established following gastrectomy for bleeding gastric vessels.
    • Further evaluation revealed CDI, central hypothyroidism, and central adrenal insufficiency.

    Findings:

    • Magnetic resonance imaging (MRI) of the pituitary showed thickening of the infundibular stalk.
    • The thickening was attributed to infiltrative lymphoma affecting the pituitary infundibular stalk.
    • This infiltration led to multifocal pituitary dysfunction.

    Implications:

    • Thickened pituitary infundibulum on imaging can suggest CDI in the presence of other symptoms.
    • Lymphoma infiltration of the pituitary stalk is an uncommon cause of CDI and hypopituitarism.
    • This case underscores the importance of considering malignancy in unexplained endocrine deficiencies.
    Abstract

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