Pituitary and adrenal involvement in diffuse large B-cell lymphoma, with recovery of their function after chemotherapy

BMC Endocrine Disorders

Ryoichi Takayanagi¹  Masatoshi Nomura¹  Takamitsu Matsushima¹  Motohiko Ikeda¹  Hirofumi Ohno¹  Noriyuki Miyata¹  Yayoi Matsuda¹  Ichiro Abe¹  Motoaki Shiratsuchi¹  Yasuhiro Nakashima¹ 

[1] Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan

关键词: Recovery of pituitary and adrenal function;    Autologous hematopoietic stem cell transplantation;    Panhypopituitarism;    Diffuse large B-cell lymphoma;    Adrenal lymphoma;    Pituitary lymphoma;   

Others  :  1085587
DOI  :  10.1186/1472-6823-13-45

 received in 2013-03-18, accepted in 2013-09-19,  发布年份 2013

【 摘 要 】

Background

Diffuse large B-cell lymphoma sometimes involves the endocrine organs, but involvement of both the pituitary and adrenal glands is extremely rare. Involvement of these structures can lead to hypopituitarism and adrenal insufficiency, and subsequent recovery of their function is rarely seen. The present report describes an extremely rare case of pituitary and adrenal diffuse large B-cell lymphoma presenting with hypopituitarism and adrenal insufficiency with subsequent recovery of pituitary and adrenal function after successful treatment of the lymphoma.

Case presentation

A 63-year-old Japanese man was referred to our hospital due to miosis, ptosis, hypohidrosis of his left face, polydipsia and polyuria. ¹⁸F-fluorodeoxy glucose positron emission tomography / computed tomography revealed hotspots in the pituitary gland, bilateral adrenal glands and the apex of his left lung. Surgical biopsy from the pituitary lesion confirmed the diagnosis of diffuse large B-cell lymphoma, with lymphoma cells replacing normal pituitary tissue. Endocrine function tests revealed adrenal insufficiency and panhypopituitarism, including a possible affection of the posterior pituitary. Hormone replacement therapy with desmopressin and hydrocortisone was started. Chemotherapy consisted of six courses of R-CHOP (rituximab, cyclophosphamide, vincristine, doxorubicin and prednisolone) and two courses of high-dose methotrexate followed by autologous hematopoietic stem cell transplantation. Subsequently, his pituitary and bilateral adrenal lesions resolved, and serial endocrine function tests showed gradual improvement in pituitary and adrenal function.

Conclusions

The present report describes an extremely rare case of diffuse large B-cell lymphoma with involvement of both the pituitary and bilateral adrenal glands. R-CHOP and high-dose methotrexate therapy followed by autologous hematopoietic stem cell transplantation was quite effective, and panhypopituitarism and adrenal insufficiency improved to almost normal values after successful treatment of the lymphoma with chemotherapy.

【 授权许可】

   
2013 Nakashima et al.; licensee BioMed Central Ltd.

【 图 表 】

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