Endocrine Abstracts

Introduction: The causes of gonadotropic insufficiency are many and varied. Pituitary lymphomas are a rare and difficult-to-diagnose cause.

Case report: We report the case of a 30-year-old female patient who was admitted to the internal medicine department for an altered general condition with febrile headache. She reported secondary amenorrhea evolving for three months. The pregnancy test was negative. On physical examination, the patient was cachectic and pale. She had ptosis of the right eye, associated with extrinsic nerve III paralysis and anesthesia of the right hemiface. Specialized biology of the hypothalamic-pituitary axis showed gonadotropic insufficiency, with follicle-stimulating hormone at 1.2 mIU/l (1.5-2.4) and luteinizing hormone below 0.1 mIU/l (1.7-8.6), with moderate hyperprolactinemia at 26 ng/ml (n<15). The corticotropic, thyrotropic and somatotropic axes were normal. Pituitary MRI revealed a voluminous 21 mm long axis T1, T2 iso-signal sellar process with heterogeneous enhancement after gadolinium injection associated with diffuse pachymeningeal enhancement. Abdominal CT showed infiltrative pancreatic, lymph node and bone involvement. A diagnosis of lymphoblastic B lymphoma was made on peritoneal CT biopsy with multiple localizations: abdominal, bone and pituitary. The patient was treated with chemotherapy.

Conclusions: Lymphomas of the pituitary stem are extremely rare tumours, with symptoms dominated by headache, asthenia and diplopia. Imaging can determine whether this thickening is isolated or associated with other lesions, which are more easily accessible to biopsy.