ECE2014 Poster Presentations Pituitary Clinical (<emphasis role="italic">Generously supported by IPSEN</emphasis>) (108 abstracts)
Acut monocytic leukemia with pituitary involvement; a case report
Mazhar Müslüm Tuna 1 , Berna Afacan Öztürk 2 , Narin Nasıroğlu İmga 1 , Berçem Ayçiçek Doğan 1 , Serhat Işık 1 , Simten Dağdaş 2 , Gülsüm Özet 2 , Dilek Berker 1 & Serdar Güler 1
1Ankara Numune Training and Resarch Hospital Endocrinology Department, Ankara, Turkey; 2Ankara Numune Training and Resarch Hospital Hematology Department, Ankara, Turkey.
İntroduction: CNS involvement is rare in acute monocytic leukemia cases. Pituitary involvement seems much more rarely with unknown frequency. Here, we present a case of AML- M5 (FAB classification) patient with pituitary involvement.
Case presentation: A 29 years old, male patient, admitted to hematology clinic with visual disturbance and poor performance status. Allogeneic hematopoietic stem cell transplantation was performed in 2010 after chemotherapy with diagnosis of acute monocytic leukemia. During follow-up in remission, the patient had visual disturbance in lefte eye and poor performance status. Central facial paralysis and visual loss was found in physical examination and relaps of leukemia was diagnosed. Leukemic infiltration of pituitary gland, infindibulum, optic chiasm and brain parencyhme was seen at cranial MRI. Radiotherapy and dexamethasone therapy were planned. Endocrinologic assesment was made; fasting blood glucose, sodium, potatium, liver and renal function tests were in normal limits. Pituitary hormon levels were all depressed. L-thyroxine replacement was started due to panhypopituitarism. After the initiation of this treatment urine output was noticed 6000–7000 cc per day and serum osmolality decreased from 298 to 96 mOsm/l. Water deprivation test was performed and 5% of body weight was lost; urinary specific gravity was increased by 50% following vasopressin administration. Nasal DDAVP was started with diagnosis of central diabetes insipidus. Polyuria and polydipsia was improved under minirin treatment. Following the completion of radiotherapy treatment the patient was discharged with recommendation of outpatient control.
Discussion: Acute myeloid leukemia (AML) is rarely associated with diabetes insipidus (DI) and hypopituitarism. Adrenal insufficiency and hypothyroidism may mask diabetes insipidus so steroid and thyroxine treatment can cause diabetes insipidus become apparent.
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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