Primary central nervous system lymphoma in childhood presenting as progressive panhypopituitarism.
We report a 15-year-old boy who had isolated central diabetes insipidus initially diagnosed at age 11 years. A brain magnetic resonance imaging (MRI) was normal at the time. At age 12 years, growth hormone (GH) testing was performed because of a decline in linear growth rate and demonstrated GH deficiency. After a repeat normal brain MRI, GH therapy was begun. Three years later, hormonal testing revealed prepubertal gonadotropins and low testosterone levels, free thyroxine index, and morning cortisol levels. Repeat brain MRI demonstrated a 9-mm enhancing lesion in the region of the pituitary stalk. The pathologic diagnosis was that of a high-grade malignant B-cell lymphoma, suggestive of Burkitt Lymphoma. Growth hormone therapy has not been associated with an increased incidence of lymphoma. This report underscores the need for vigilance in follow-up brain imaging and hormonal evaluation in children with diabetes insipidus, especially those with evolving anterior hormone deficiencies.
Silfen
M E
ME
Division of Pediatric Endocrinology, Columbia-Presbyterian Medical Center, New York, New York 10032, USA.
Garvin
J H
JH
Hays
A P
AP
Starkman
H S
HS
Aranoff
G S
GS
Levine
L S
LS
Feldstein
N A
NA
Wong
B
B
Oberfield
S E
SE
D000293:Adolescent; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D002051:Burkitt Lymphoma / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy / Q000235:genetics / Q000473:pathology; D003520:Cyclophosphamide / Q000008:administration & dosage; D003561:Cytarabine / Q000008:administration & dosage; D003919:Diabetes Insipidus / Q000209:etiology; D018450:Disease Progression; D004317:Doxorubicin / Q000008:administration & dosage; D004393:Dwarfism, Pituitary / Q000188:drug therapy / Q000209:etiology; D005188:False Negative Reactions; D020022:Genetic Predisposition to Disease; D019382:Human Growth Hormone / Q000009:adverse effects / Q000627:therapeutic use; D006801:Humans; D006854:Hydrocortisone / Q000008:administration & dosage; D007018:Hypopituitarism / Q000097:blood / Q000209:etiology*; D007037:Hypothyroidism / Q000209:etiology; D008228:Lymphoma, Non-Hodgkin / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy / Q000235:genetics / Q000473:pathology; D008279:Magnetic Resonance Imaging; D008297:Male; D008727:Methotrexate / Q000008:administration & dosage; D010907:Pituitary Hormones / Q000097:blood / Q000172:deficiency; D010911:Pituitary Neoplasms / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy / Q000235:genetics / Q000473:pathology; D011241:Prednisone / Q000008:administration & dosage; D012074:Remission Induction; D014750:Vincristine / Q000008:administration & dosage
D010907:Pituitary Hormones; D003561:Cytarabine; D019382:Human Growth Hormone; D014750:Vincristine; D004317:Doxorubicin; D003520:Cyclophosphamide; D011241:Prednisone; D006854:Hydrocortisone; D008727:Methotrexate