title: Panhypopituitarism as an initial manifestation of primary central nervous system non-Hodgkin's lymphoma.
abstract: OBJECTIVE
  To report an unusual case of primary central nervous system non-Hodgkin's lymphoma in which the initial manifestation was panhypopituitarism.
  
  
  METHODS
  We present a retrospective case review and discuss similar cases from the literature.
  
  
  RESULTS
  A 64-year-old woman with nausea, vomiting, diarrhea, and peripheral and periorbital edema was found to have panhypopituitarism. Magnetic resonance imaging showed minimal enlargement of the pituitary, and a transsphenoidal biopsy of the pituitary was nondiagnostic. Months later, abnormalities of extraocular movements developed. Repeated imaging and a second transsphe-noidal biopsy did not reveal the ultimate diagnosis. When further neurologic signs and symptoms subsequently developed, a right temporal open craniotomy was performed. It was not until this procedure, the patient's third biopsy, that the cause of her illness was discovered to be diffuse large cell lymphoma.
  
  
  CONCLUSIONS
  Although idiopathic panhypopituitarism is a relatively common clinical entity, it remains a diagnosis of exclusion. The development of associated neurologic signs should prompt the clinician to initiate a new search for an underlying cause. This case underscores the protean manifestations of central nervous system lymphoma, both endocrine and neurologic, and the difficulties that may be encountered in attempts to establish a diagnosis.
authors.affiliation: Department of Ophthalmology and Visual Sciences and John A. Moran Eye Center, University of Utah Health Sciences Center, Salt Lake City, Utah 84132, USA.
authors.forename: Bradley J
authors.initials: BJ
authors.lastname: Katz
authors.forename: Robert E
authors.initials: RE
authors.lastname: Jones
authors.forename: Kathleen B
authors.initials: KB
authors.lastname: Digre
authors.forename: Judith E A
authors.initials: JE
authors.lastname: Warner
authors.forename: Kevin R
authors.initials: KR
authors.lastname: Moore
mesh_terms: D020434:Abducens Nerve Diseases / Q000209:etiology; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D001905:Botulinum Toxins / Q000627:therapeutic use; D016543:Central Nervous System Neoplasms / Q000150:complications* / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000473:pathology; D017809:Fatal Outcome; D005260:Female; D006261:Headache / Q000209:etiology; D006801:Humans; D007018:Hypopituitarism / Q000000981:diagnostic imaging / Q000209:etiology* / Q000473:pathology; D008228:Lymphoma, Non-Hodgkin / Q000150:complications* / Q000188:drug therapy / Q000473:pathology; D008279:Magnetic Resonance Imaging; D009325:Nausea / Q000209:etiology; D011877:Radionuclide Imaging; D014839:Vomiting / Q000209:etiology
chemical_list: D001905:Botulinum Toxins