open access

Vol 7, No 2 (2016)
Case report
Published online: 2016-11-09
Get Citation

Hypopituitarism in a patient with Hodgkin lymphoma

Monika Chełstowska, Ewa Lech-Marańda, Krzysztof Warzocha
DOI: 10.5603/Hem.2016.0012
·
Hematologia 2016;7(2):161-166.

open access

Vol 7, No 2 (2016)
CASE REPORTS
Published online: 2016-11-09

Abstract

This paper describes a patient with Hodgkin lymphoma (HL) treated with first-line immunochemotherapy A + AVD (brentuximab, doxorubicine, vinblastine, dacarbazine). During cytostatic treatment, the patient developed multi-axis hypopituitarism requiring hormone substitution, which subsided after several months of hormone therapy. Pituitary imaging studies (CT, MRI) showed an infiltration lesion of the pituitary, which was not histologically verified because consent was withheld. In a differential diagnosis, autoimmune inflammation of the pituitary was taken into account, however lymphoma infiltration seemed less likely, because of the overall clinical presentation. First-line treatment was continued for 6 cycles of A + AVD chemotherapy and complete metabolic remission was achieved as measured by PET-CT. The potential mechanisms of transient hypopituitarism are then discussed in this patient treated with immunochemotherapy for HL.

Abstract

This paper describes a patient with Hodgkin lymphoma (HL) treated with first-line immunochemotherapy A + AVD (brentuximab, doxorubicine, vinblastine, dacarbazine). During cytostatic treatment, the patient developed multi-axis hypopituitarism requiring hormone substitution, which subsided after several months of hormone therapy. Pituitary imaging studies (CT, MRI) showed an infiltration lesion of the pituitary, which was not histologically verified because consent was withheld. In a differential diagnosis, autoimmune inflammation of the pituitary was taken into account, however lymphoma infiltration seemed less likely, because of the overall clinical presentation. First-line treatment was continued for 6 cycles of A + AVD chemotherapy and complete metabolic remission was achieved as measured by PET-CT. The potential mechanisms of transient hypopituitarism are then discussed in this patient treated with immunochemotherapy for HL.

Get Citation

Keywords

Hodgkin lymphoma, hypopituitarism, immunotherapy

About this article
Title

Hypopituitarism in a patient with Hodgkin lymphoma

Journal

Hematology in Clinical Practice

Issue

Vol 7, No 2 (2016)

Article type

Case report

Pages

161-166

Published online

2016-11-09

DOI

10.5603/Hem.2016.0012

Bibliographic record

Hematologia 2016;7(2):161-166.

Keywords

Hodgkin lymphoma
hypopituitarism
immunotherapy

Authors

Monika Chełstowska
Ewa Lech-Marańda
Krzysztof Warzocha

References (21)
  1. Tamer G, Kartal I, Aral F. Pituitary infiltration by non-Hodgkin's lymphoma: a case report. J Med Case Rep. 2009; 3: 92–93.
  2. Lee S, Abel C, Gabriel C, et al. Non-Hodgkin's lymphoma presenting as anterior hypopituitarism. Endocrine Abstracts. 2013; 32: 252.
  3. Kenchaiah M, Hyer SL. Diffuse large B-cell non Hodgkin's lymphoma in a 65-year-old woman presenting with hypopituitarism and recovering after chemotherapy: a case report. J Med Case Rep. 2011; 5: 498.
  4. Sawada Y, Ishii S, Koga Y, et al. Reversible Hypopituitarism Associated with Intravascular Large B-Cell Lymphoma: Case Report of Successful Immunochemotherapy. Tohoku J Exp Med. 2016; 238(3): 197–203.
  5. Kaufmann TJ, Lopes MB, Laws ER, et al. Primary sellar lymphoma: radiologic and pathologic findings in two patients. AJNR Am J Neuroradiol. 2002; 23(3): 364–367.
  6. Landman RE, Wardlaw SL, McConnell RJ, et al. Pituitary lymphoma presenting as fever of unknown origin. J Clin Endocrinol Metab. 2001; 86(4): 1470–1476.
  7. Huang YY, Lin SF, Dunn Po, et al. Primary pituitary lymphoma presenting as hypophysitis. Endocr J. 2005; 52(5): 543–549.
  8. Wróbel T. Chłoniak Hodgkina. In: Zalecenia postępowania diagnostyczno-terapeutycznego w nowotworach złośliwych — 2013 r. Via Medica, Gdańsk : 981–990.
  9. Bolanowski M, Kuliszkiewicz-Janus M, Sokolska V. Rozlany chłoniak złośliwy typu B przebiegający z naciekiem skrzyżowania wzrokowego, zaburzeniami widzenia, niedoczynnością przysadki, hiperprolaktynemią i moczówką prostą. Opis przypadku i przegląd literatury. Endokrynol Pol. 2006; 6: 642–647.
  10. McCormick PC, Post KD, Kandji AD, et al. Metastatic carcinoma to the pituitary gland. Br J Neurosurg. 1989; 3(1): 71–79.
  11. Akkas BE, Vural GU. The incidence of secondary central nervous system involvement in patients with non-Hodgkin's lymphoma as detected by 18F-FDG PET/CT. Nucl Med Commun. 2013; 34(1): 50–56.
  12. Friedberg JW, Chengazi V. PET scans in the staging of lymphoma: current status. Oncologist. 2003; 8(5): 438–447.
  13. Cheson BD, Fisher RI, Barrington SF, et al. Alliance, Australasian Leukaemia and Lymphoma Group, Eastern Cooperative Oncology Group, European Mantle Cell Lymphoma Consortium, Italian Lymphoma Foundation, European Organisation for Research, Treatment of Cancer/Dutch Hemato-Oncology Group, Grupo Español de Médula Ósea, German High-Grade Lymphoma Study Group, German Hodgkin's Study Group, Japanese Lymphorra Study Group, Lymphoma Study Association, NCIC Clinical Trials Group, Nordic Lymphoma Study Group, Southwest Oncology Group, United Kingdom National Cancer Research Institute. Recommendations for initial evaluation, staging, and response assessment of Hodgkin and non-Hodgkin lymphoma: the Lugano classification. J Clin Oncol. 2014; 32(27): 3059–3068.
  14. Thodou E, Asa SL, Kontogeorgos G, et al. Clinical case seminar: lymphocytic hypophysitis: clinicopathological findings. J Clin Endocrinol Metab. 1995; 80(8): 2302–2311.
  15. Krysiak R , Okopień B , Herman Z S Zapalenie przysadki mózgowej Przegl Lek. 2007; 64: 515–520.
  16. O'Day SJ, Maio M, Chiarion-Sileni V, et al. Efficacy and safety of ipilimumab monotherapy in patients with pretreated advanced melanoma: a multicenter single-arm phase II study. Ann Oncol. 2010; 21(8): 1712–1717.
  17. Blansfield JA, Beck KE, Tran K, et al. Cytotoxic T-lymphocyte-associated antigen-4 blockage can induce autoimmune hypophysitis in patients with metastatic melanoma and renal cancer. J Immunother. 2005; 28(6): 593–598.
  18. Ribas A, Kefford R, Marshall MA, et al. Phase III randomized clinical trial comparing tremelimumab with standard-of-care chemotherapy in patients with advanced melanoma. J Clin Oncol. 2013; 31(5): 616–622.
  19. Lesokhin AM, Ansell SM, Armand P, et al. PD-1 blockade with nivolumab in relapsed or refractory Hodgkin's lymphoma. N Engl J Med. 2015; 372(4): 311–319.
  20. Topalian SL, Hodi FS, Brahmer JR, et al. Safety, activity, and immune correlates of anti-PD-1 antibody in cancer. N Engl J Med. 2012; 366(26): 2443–2454.
  21. Tarkowski M. Expression and a role of CD30 in regulation of T-cell activity. Curr Opin Hematol. 2003; 10(4): 267–271.

Regulations

Important: This website uses cookies. More >>

The cookies allow us to identify your computer and find out details about your last visit. They remembering whether you've visited the site before, so that you remain logged in - or to help us work out how many new website visitors we get each month. Most internet browsers accept cookies automatically, but you can change the settings of your browser to erase cookies or prevent automatic acceptance if you prefer.