Endocrine Abstracts

Introduction: Panhypopituitarism is a known but rare presentation of lymphoproliferative disease. We describe a patient with newly diagnosed advanced diffuse large B-cell lymphoma who presented with anterior hypopituitarism and concomitant adrenal gland involvement.

Case report: A 72 year-old Chinese woman presented with a few weeks’ duration of lethargy, weight loss and functional decline. A hormonal screen done at admission suggested central hypothyroidism, and an MRI of the brain performed showed pituitary stalk thickening without abnormalities in the size and morphology of the gland. Evaluation of the other hormonal axes revealed the presence of central hypocortisolism, secondary hypogonadism and low IGF1 levels. In addition, a computed tomography scan done as part of work-up for a right hilar mass seen on a screening chest radiograph revealed bilateral adrenal masses with surrounding enlarged para-aortic lymph nodes. Histology of the adrenals was diagnostic of a diffuse large B-cell lymphoma and a work-up for other causes was inconclusive. Our patient was not subjected to a pituitary biopsy as there was sufficient evidence of lymphomatous infilitration of the gland from the clinical findings. She was started on six cycles of R-CHOP chemotherapy along with thyroxine and glucocorticoid replacement. The patient had no features of diabetes insipidus before or after treatment. With the completion of chemotherapy, there has not been any functional recovery of the hormonal axes and our patient is currently still receiving hormonal replacement.

Conclusion: Panhypopituitarism is a rare but important aetiological consideration in the older patient presenting with functional decline. Our patient’s presentation of isolated anterior hypopituitarism was unusual, as secondary lymphomatous involvement has a tendency to affect the posterior lobe instead due to its direct blood supply from the systemic circulation, unlike in the anterior lobe.