An 82-year-old woman suffering from general malaise with persistent hyponatremia was referred to our facility. Laboratory tests revealed hypocortisolemia and hypothyroidism. Despite replacement with hydrocortisone and levothyroxine, her condition deteriorated to an unconscious state. Magnetic resonance imaging demonstrated a hypothalamic tumor with marked gadolinium enhancement (Picture A). No lymph nodes were systemically swollen. All anterior pituitary hormones showed delayed and impaired responses to stimulation by hypothalamic hormones, indicating broad hypothalamic dysfunction (Picture B). Since polyuria and hypernatremia were also shown, desmopressin was administered for unmasked central diabetes insipidus. Since a stereotactic brain biopsy revealed the pathology of diffuse large B cell lymphoma (Picture C) in the hypothalamus, whole-brain radiation was selected for primary central nervous system lymphoma (PCNSL) due to the patient's general condition. PCNSL occurs commonly in the periventricular region and rarely in the hypothalamus (1). Hypothalamic PCNSL causes various pituitary dysfunctions (2), and its possibility should be considered in elderly patients with hypothalamic disorders.
Picture.
The authors state that they have no Conflict of Interest (COI).
References
- 1. Löw S, Batchelor TT. Primary central nervous system lymphoma. Semin Neurol 38: 86-94, 2018. [DOI] [PubMed] [Google Scholar]
- 2. Tanki HN, Malik KN, Makhdoomi R, Feroz S, Ramzan AU. Primary hypothalamic lymphoma in an adult male; a case report and literature review. Oman Med J 33: 346-351, 2018. [DOI] [PMC free article] [PubMed] [Google Scholar]