title: A relapsed non-Hodgkin lymphoma presenting as panhypopituitarism successfully treated by chemotherapy.
abstract: We report a case of relapsed large B-cell non-Hodgkin lymphoma (NHL) affecting the anterior pituitary. The NHL relapsed after three years in complete remission. The patient was a 72-year-old woman who presented fever, weakness, hyponatremia, and hypotension. The levels of thyroid-stimulating hormone and gonadotropins were very low and magnetic resonance imaging showed infiltration of the pituitary gland and stalk. After controlling the hormonal deficiencies with substitution using hydroxycortisone and levothyroxin, the patient was treated with combination chemotherapy using cyclophosphamide, vincristine, mitoxantrone, etoposide, and bleomycin (VNCOP-B regimen), achieving a complete regression of the pituitary mass and partial recovery of the endocrine function. Lymphoproliferative disorders affecting the anterior pituitary are exceedingly rare, with only six cases in immunocompetent adults reported in the literature. To our knowledge this is the first report of a relapsed NHL presenting by hypopituitarism.
authors.affiliation: Department of Clinical Hematology, Institut Català d'Oncologia, L'Hospitalet de Llobregat, Barcelona, Spain.
authors.forename: Tomas
authors.initials: T
authors.lastname: Büchler
authors.forename: Christelle
authors.initials: C
authors.lastname: Ferra
authors.forename: Nuria
authors.initials: N
authors.lastname: Virgili
authors.forename: Eduard
authors.initials: E
authors.lastname: Montanya
authors.forename: Albert
authors.initials: A
authors.lastname: Grañena
mesh_terms: D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D001761:Bleomycin / Q000627:therapeutic use*; D003520:Cyclophosphamide / Q000627:therapeutic use*; D005047:Etoposide / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D007018:Hypopituitarism / Q000175:diagnosis / Q000209:etiology*; D008228:Lymphoma, Non-Hodgkin / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy*; D008279:Magnetic Resonance Imaging; D008942:Mitoxantrone / Q000627:therapeutic use*; D009364:Neoplasm Recurrence, Local / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy*; D011241:Prednisone / Q000627:therapeutic use*; D016896:Treatment Outcome; D014750:Vincristine / Q000627:therapeutic use*
chemical_list: D001761:Bleomycin; D014750:Vincristine; D005047:Etoposide; D003520:Cyclophosphamide; D008942:Mitoxantrone; D011241:Prednisone