Primary central nervous system lymphoma presenting with panhypopituitarism and diabetes insipidus
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Montana Suwannasarn1, MD, Pongamorn Bunnag1, MD, Wattana Mahattanakul2, MB, BS, MRCS, Piyaphon Cheecharoen3, MD, Arunee Singhsnaeh4, MD. 1Department of Medicine, 2Department of Neurosurgery, 3Department of Radiology,4Department of Pathology Correspondence: Arunee Singhsnaeh, MD Department of Pathology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand. Tel.: +66 2 201 1432: E-mail: firstname.lastname@example.org Received : 20 February 2014 Accepted : 10 March 2014
Lymphoma involving the hypothalamus is very rare. We present a case of a 48-year-old man with primary central nervous system lymphoma (PCNSL) presenting with hypothalamic and pituitary stalk lesions with frontal masses, causing diabetes insipidus and panhypopituitarism. Brain MRI with gadolinium enhancement demonstrated vivid enhancing hypothalamic and pituitary stalk lesions with frontal masses. Brain biopsy and subsequent histopathological examination were compatible with diffuse large B-cell non-Hodgkin’s lymphoma. After treatment with six cycles of intravenous high dose methotrexate-based chemotherapy, there was complete resolution of MRI finding. Steroid replacement was withdrawn but diabetes insipidus, hypothyroidism and hypogonadotrophic hypogonadism persisted. Regular follow up with adequate hormone replacement is crucial even there is apparent resolution of the tumor.